Occupational Business License Application Form (Page 3 of 3) in pdf

Occupational Business License Application Form Page 3

11. AM OUNT OF L I CENSE FEE DUE WI TH THI S APPL I CATI ON

The City of Owensboro requires the payment of a $47 minimum license fee with this application, unless being filed by a non-profit

organization or by an applicant under 18 years of age. Daviess County requires no payment with this application. If you answered

Yes to question A in Section 9, unless exempt as described above, submit $47 with the application. If you answered No to question

A in Section 9 no payment is required to be made with the application. M AK E CHECK PAYABL E TO: OCCUPATI ONAL TAX

ADM I NI STRATOR if payment is required. M AI L TO: Occupational Tax Administr ator

PO Box 10008

Owensbor o, K Y 42302

12. BUSI NESS L OCATI ON I NFORM ATI ON

A.) Proposed Use of Location:

B.) Existing Use of Location:

C.) Approximate Building Area Size:

D.) Total Number of Off-street Parking Spaces:

E.) Are major alterations planned:

YES

If yes, give brief

explanation:

F.) Is the applicant the owner of the premises to be licensed? ______ YES _______ NO If the answer is no give:

)

NAME (Premise Owner

Address

DENI AL TO DEL I NQUENT TAXPAYERS

NO LICENSE WILL BE ISSUED TO ANY BUSINESS WHICH OWES THE CITY OF OWENSBORO OR DAVIESS COUNTY ANY

DELINQUENT REAL ESTATE OR TANGIBLE TAXES OR ANY OCCUPATIONAL OR PAYROLL WITHHOLDING

LICENSE FEES OR ANY OTHER FEE, TAXES, OR ASSESSMENTS OF ANY KIND.

I hereby certify all information and statements herein are true and correct.

SIGNED x

Date

Print Name

Official Title

(Owner, Partner, Member, Treasurer, Agents, Etc.)

13. CI TY OF OWENSBORO BUSI NESS L OCATI ON APPROVAL

If your business is located in the City of Owensboro your business location must be inspected and approved

by the following department.

Planning & Zoning Administrator/Building Inspector (270) 687-8656

COMMENTS:

Occupational Business License Application Form Page 3