CITY OF CAMERON
APPLICATION FOR OCCUPATION LICENSE

Business Name: _________________________________________________

Business Address: _______________________________________________

Business Telephone: ______________________________________________

Mo. Sales Tax Number: ___________________________________________

Description of Business: ___________________________________________

Applicant's Name: _______________________________________________

Home Address: _________________________________________________

Home Telephone: ________________________________________________

Gross Receipts (please check one)
$         0 to  $24,999-  $10.00                    $200,000 to $499,999 - $40.00
$25,000 to  $49,999 - $20.00                    $500,000 and over -       $50.00
$50,000 to  $199,000-$30.00

No license will be issued unless you comply with all City ordinances, including but not limited to, Zoning Regulations, Nuisance Ordinances and Fire Codes. Also, you must not be delinquent in the payment of Real Estate Taxes and Personal Property Taxes.

Each applicant for a license agrees to allow the City to inspect his/her place of business prior to issuance of the license and thereafter to determine in licenses is in compliance.

Any licensed business found to in violation of a City ordinance is subject to license suspension and/or revocation.

                                                                ________________________________
                                                                 Signature of Applicant