TOWN OF
LICENSE APPLICATION
Please print or
type this form:
Name of Establishment:
____________________________________________________________________________________
Address of Establishment: ____________________________________________________________________________________
Name of Applicant: ____________________________________________________________________________________
(First) (Middle) (Last)
APPLICATION FOR THE SELLING
OF NON-INTOXICATING BEVERAGES (SODA)
The undersigned hereby applies
for a license to engage in the business of selling Non-Intoxicating Beverages.
Amount Due: $5.00 License Number: _____________________
APPLICATION FOR CIGARETTE LICENSE
The undersigned hereby makes applies for a license to manufacture, exchange, barter, dispose of, give away,
and keep for sale, cigarette paper and cigarette wrappers made or prepared for the purpose of being filled with
tobacco for smoking on said premises.
Amount Due: $25.00 License Number: _____________________
APPLICATION TO OPERATE AMUSEMENT DEVICES
The undersigned hereby applies for a
license to engage in the business of operation of Amusement Device(s).
Indicate the number of each type of machine on premises.
Juke Box____________ Pool Table____________ Video____________ Other____________
Specific Names of Video Games: ______________________________________________________________________________________________