Application For Occupational License - Town Of Church Point, La Page 4
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4Business Name: ______________________
Mailing Address: _____________________
City, State, Zip: _______________________
Account: ________________
RDS
STATE OF LOUISIANA
PARISH OF ACADIA
TOWN OF CHURCH POINT
AFFIDAVIT
I, ________________________________, OWNER/OFFICE OF ______________________________________
(Print Name)
(Print Name of Business)
do hereby certify that the gross sales of $ ______________________________ is a true and correct report of the
most recent annual gross sales for the business named above as is required by Louisiana Revised Statute 47:354
through 47:358.
______________________________________
Print Name
______________________________________
Title
______________________________________
Signature
**NOTE** THIS AFFIDAVIT MUST BE RETURNED ALONG WITH YOUR RENEWAL APPLICATION.
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Parent category: Financial