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CITY OF BUCKNER
APPLICATION FOR BUSINESS/OCCUPATIONAL LICENSE
315 S Hudson, Buckner, MO 64016 / 816-650-3191 or 816-650-9797 (fax
)

Due: April 1st, Delinquent May1st / Yearly Application Fee: $50.00

New Renewal  

Date of application   

Legal Name of Business

(  ) Individual (  ) Partnership (   ) Corp.

Business Street Address
City
State
Zip


Mailing Address (If different from above)



Type and/or Nature of Business & Description of Merchandise to be Sold or Services to be Rendered




Name & Address of Owners of Officers









Contact Person
Title
Business Phone
Other Phone Numbers



Contact Name after hours in an emergency


State Sales Tax ID Number:  

Federal ID Number:  


Number of Employees:___  Full Time: ___Part Time: ___
Business Hours:  


Do You Sell Cigarettes?  

Over the counter?  

By vending Machine?  


Name of Cigarette Vendor:
State Retail Sales T
ax Number of Vendor:  

Mail Check or Money Order Payable To:
Attn: Licensing Department City of Buckner
P.O. Box 377
Buckner, Missouri 64016




I, the undersigned, do hereby declare that the above information submitted to the City of Buckner, for the purpose of obtaining an occupational license for the above described business, is true and correct to the best of my knowledge.



Signature Title


315 S Hudson • P.O. Box 377 • Buckner, Missouri 64016 • Phone: (816) 650-3191 • Fax: (816) 650-9797