DOYLE4fj(/ BUS. LIC. NO.
1992 BUSINESS LICENSE APPLICATION FORM II"I'I'll'III'll�'I
51
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*APPROVED INITIALS DATE
*DENIED INITIALS DATE
******************************************************************
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES NO
2. Business Name: -aeth
3. Business Address: 14-Ve f ✓bio 4. Mailing Address:. ',S-4(ke—
�a.
5. Business.. Phone: ( 611 ) ..-S-6Y — Q -0,5"a..
6. Owned By: CORPORATION PARTNERSHIP INDIVIDU
7.
If Corporation or
Partnership: Tax I.D.#
8.
If Individual Owner:
Social Security #/
7 3-�
Icl
• 9.
Name of Owner kqz-�t:�
L)O
Title:
1'1dYi,
Or Officers
h�•n�,
10.
Type of Business:
1�1GU / me 8r-
11.
SBE Resale Number:
Y1 D re-S0.
f s-
�c��5c rtt Ss
12. BUSINESS LOCATED WITHIN THE CITY OF LA QUINTA (Does Not Apply To
Building Contractors):
A. Estimated Gross Business Receipts for New Businesses Only:
$ 60. 0
B. Previous.Year Gross Receipts For Established Businesses:
"//9
********GOOD ONLY FOR JANUARY 1,1992 THRU DECEMBER 31,1992*******
I HEREBY CERTIFY that all the information supplied by me is correct and
any licenses required by the County, State or Federal Government have been
issued to me and are in full force and effect.
45�zl�� 0? y /1-6v /7791
01JIFfirt,
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box.1504
La Quinta, CA 92253
Date