APPENDIX A: PRIVILEGE LICENSE APPLICATION FORM

NAME OF BUSINESS:                                                                                                             

BUSINESS ADDRESS:                                                                                                            

MAILING ADDRESS:                                                                                            

IS BUSINESS A:   (check one)

            (   )   Individual

            (   )   Partnership

            (   )   Corporation

            (   )   Other Entity

NATURE OF BUSINESS:                                                                                                          

IS BUSINESS REGULATED BY A STATE OCCUPATIONAL LICENSING BOARD?:

                (   ) YES   (   ) NO

If yes, give the state license serial number:

First License #:                                                               

Second License #:                                                                                                             

Third License #:                                                                                                             

Fourth License #:                                                                                                             

THE FOLLOWING ACTIVITIES PERTAIN TO MY BUSINESS:

ACTIVITY                  LICENSE TAX

   - IMPORTANT, see next page -

   Privilege License Application, Page 2

I do solemnly affirm that the statements made in the foregoing application is true to the best of my knowledge and belief.

                        Name:                                                          

                        Title:                                                          

   • Send check with application

   • Make check payable to the Town of Fletcher

   • License will be issued upon receipt of payment

   • For further information call: 704/687-3985 or write:

Town of Fletcher, Town Administrator, P.O. Drawer 369, Fletcher, NC 28732

G.S. § 105-109 - All licenses shall be paid on or before April 1 of each year, or at the date of engaging in the business. If not paid by April 1 as stated, an additional tax of 5% will be imposed for each and every 30 days or fraction thereof.