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1992 BUSINESS LICENSE APPLICATION FORM
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BUS• LIC. N0.
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S051ti.CA�H lib TO�A� is-yam
*APPROVED INITIALS _Z' _ DATE
*DENIED INITIALS DATE
******************************************************************
1. IS THIS BUSINESS LOCATED AT YOUR HOME: YES NO
2. Business Name: .�cl•C���iTQ,vv� ,��Ti f\r�1G�i
3. Business Address: yh-I�U`�2 4. Mailing Address:
5. Business Phone:( C:, I q -�G)-7
6. Owned By: CORPORATION PARTNERSHIP INDIVIDUAL
7. If Corporation or Partnership: Tax I.D.#
8. If Individual Owner: Social Security
9. Name of owner ,�� �� l�►,1d-t re Title:
Or Officers
10. Type of Business:
66.00 A
11. SBE Resale Number: V%%�-
.
12. BUSINESS LOCATED WITHIN THE CITY OF LA QUINTA (Does Not Apply To
Building Contractors):
A. Estimated Gross Business Receipts for New Businesses Only:
$ i`15 0 0
B.. Previous Year Gross Receipts For Established Businesses:
********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 req .red by the County, State or Federal Government have been
issued to me.,a are in full force and effect.
ignature Tit a Dlate
Submit Form To:
CITY OF LA QUINTA
BUSINESS LICENSE DIVISION
P.O. Box.1504
La Quinta, CA 92253