Form B1-685aapplication For License/registration
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41. BUSINESS
NAME
2. BUSINESS/LICENSED LOCATION (NO., STREET, ZIP)
NAME (IF CORPORATION OR PARTNERSHIP, SEE BELOW)*
4. MAILING ADDRESS (NO., STREET, CITY, STATE, ZIP)
3. OWNER'S
EMPLOY.
5. TYPE OF BUSINESS
6. DATE BUS. STARTED
7. FEDERAL
8. STATE
IDENT.
NUMBERS
OFFIC IAL
USE
9. TELEPHONE (BUSINESS)
10. TELEPHONE (HOME)
CODE NO.
DESCRIPTION
FEE
3 7 0 2
B U S I N E S S
P R I V I L E G E
L I C E N S E
$ 2 0 0 . 0 0
APPROVALS
OTHER DATA (ENGINE NO. & MAKE OF
REGIS/LIC. NO.
VEHICLES INVOLVED, ETC.)
BUS. PRIV. LIC. NO.
BUS. PRIV. LIC. TAX NO.
I hereby certify that the statements contained herein are true and correct to the best of my knowledge and belief.
I understood that if I knowingly make any false statement herein I am
subject to such penalties as may be prescribed by law or ordinance.
Applicant sign here
DEPARTMENT OF LICENSES & INSPECTIONS
APPLICATION
FOR
LICENSE/REGISTRATION
L I C E N S E
I S S U A N C E
S E C T I O N
*Use other side of card for Names of Corporate Officers or partners.
1401 John F. Kennedy Boulevard • Concourse
COMPLETE NUMBERED ITEMS AS APPLIES
Philadelphia, PA 19102
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Parent category: Business