The purpose of this permit is to register a new business, a relocated business or a home business. The annual fee for the business registration is $35.00. In addition, a $25.00 fee may be charged for safety inspection.
PLEASE USE BLACK PEN ONLY
BUSINESS INFORMATION:
Business Name: _________________________________ Owner’s Social Security Number _______________
NM CRS #:__________________________________Federal ID #:____________________________________
____New business ____Relocation of existing business ____Home business
Give a brief Description of the business: __________________________________________________________
__________________________________________________________________________________________
Initial application? ____Yes ____No
BUSINESS OWNER INFORMATION:
Name:____________________________________________________ Title:____________________________
Mailing address:________________________________________________________________
Phone:_________________ Alternate phone:_________________ Fax:____________________
BUSINESS LOCATION(S): (Please list all locations where business may be conducted.)
Street address:_______________________________________________________________________________
Zoning (please circle one): Rural Residential A Residential B Residential C Commercial Industrial
Proprietary interest in property (owner, renter, other):________________________________________________
Total area:________________ acres or sq. ft Property code: 3-_________-__________-_________-_______
(The property code # can be obtained from the County Assessor’s Office or from the tax bill)
PROPERTY OWNER INFORMATION (IF APPLICANT IS NOT OWNER AUTHORIZATION LETTER
FROM PROPERTY OWNER IS REQUIRED):
Name_________________________________________ Phone: ______________________________________
Mailing Address _______________________________________________________________________________________
ALL APPLICANTS MUST SIGN HERE
As the Applicant, I state that the information provided in this application and all attachments is true and accurate to the best of my knowledge. I also certify that I hold all necessary licenses to perform the business for which I am hereby requesting registration. I understand that misrepresentation is grounds for revocation of said business registration.
Applicant Signature ___________________________________ |
Print Name _________________________________ |
Date_______________________________________ |
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