Business License Application & Renewal

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P O Box 96 ~ New Franklin, MO ~ 65274
660 848 2288 Fax: 660 848 2183

ANNUAL BUSINESS LICENSE APPLICATION
Business License is good for the calendar year, January 1 – December 31
________________________________________

Date ____________________ Application No. ________________

Name: _____________________________ Phone: _____________________________

Address: ________________________________________________________________

Driver’s License Number: ___________________SS # or Tax ID #__________________

Name of Business: ________________________________________________________

Business Address: ________________________________________________________

Business Phone: _________________________________________________________

Type of Business: ________________________________________________________

Seasonal?: _________ If yes, months of operation: _____________________________

New Business: _______ Existing Business: ________ Years in Operation: ___________

State Sales Tax Number: ___________________________________________________

Tax Clearance Form 943 Attached? _________

If you do not have the Tax Clearance Form 943, you may go online to request a
MO No Tax Due Certificate at dor.mo.gov or the MO Department of Revenue
at 573 751 9268. A Business License will not be issued without the Tax Clearance

Chapter 287.061.1, RSMo requires verification or proof of exemption of workers’ compensation insurance from all general contractors in the construction industry applying for a municipal business license.

I am required by the State of Missouri to have workers’ comp insurance. Yes ____ No ____

If Yes, Certificate of Insurance Attached: ____ If No, Affidavit of Exemption Attached: _____

____________________________________________ _______________________
Signature & Date

_________________________________________________________________________
OFFICE USE ONLY

License Fee: ________________

VERIFYING DOCUMENTS:

Cash: ______________________ No Tax Due: ________________________

Check #: ___________________ Certificate of Ins: ____________________
or
Money Order: _______________ Worker’s Comp Exemption: __________

_________________________________________________________________________

Licenses Issue Date: ___________________ for Year: ____________________
{photo identification to be attached here}

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