209 South Main StreetP O Box 174La Veta CO 810550174719 7423631fax 719 7425420 Huerfano CountyBUSINESS LICENSE APPLICATIONPlease Print1Trade Name DBA 2Location of Business StreetAddress3Mailing A ID: 862342
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1 Town of La Veta 209 South Main Street
Town of La Veta 209 South Main Street P. O. Box 174 La Veta, CO 81055 - 0174 (719) 742 - 3631 fax (719) 742 - 5420 Huerfano County BUSINESS LICENSE APPLICATION Please Print 1. Trade Name (DBA): _____ __________________________________ ______ __________ 2. Location of Business: _ ________________________ _____ _______________________ Street Address 3. Mailing Address: ____ __________________________________ _____ _____________ _ 4. Phone#: ___________________________ Fax #: __________________________ 5. E - mail Address: ______________________________________ _____ ______________ _ 6. Owner Name: __________________________________________________ ___ _______ 7. Owner Address: ______________________________________ _____ ______________ _ 8. State Sales Tax ID: ______________ _____ ____________________________________ 9. What is the m ain o peration of the b usiness ? _________________ _______ __________ 10. Is this a h ome - based b usiness? Yes No 11. Type of Business: Retail Manufacturing Service Wholesale Trade Other (please describe) ________________________________ 12. What is the Zoning for this Business Location ? _ _____________________________ _ 13. Number of Full Time Employees: _______ ______ Part Time Employees __________ *** Attach a copy of State Sales Tax License and, if applicable , a Public Health Inspection for kit c hen *** I declare, under the penalty of perjury, that this application has been examined by me ; that the statements made herein are made in good faith pursuant to applicable tax laws and regulations, and to the best of my knowledge and belief are true, correct and complete. Signature of Applica nt : ___ _ ______ _________ ________________ Date: _ ____ __________ Title : _ _____ ______________ __________________________________________________ The Town of La Veta Business License Fee is $25.00 per year. Make check payable to “Town of La Veta.” This is an annual fee payable and due at the beginning of each year and must be renewed no later than January 15. License expires on December 31 of each year . Please mail completed application to: Town of La Veta P . O . Box 174, La Veta, CO 81055 - 0174 or deliver to - � 209 South Main Street , La Veta, CO FOR OFFICE USE ONLY License #: _____________ Date Issued: ____________