Located at_____________________________________________________________________

                  Street or road                       Mailing address                                   Phone#                               

Please enter GROSS AMOUNT OF INCOME of said business, profession or calling of the PRECEDING YEAR

 or GROSS AMOUNT OF JOB.  Amount $_________________________

  If this business is a new business, state exact date started______________

 What is the expected gross income of your business?__________________

  Are you operating your business in a rented building?  Yes_______     No_____

                       If yes, give Landlord's name and address_____________________________________

                                                                                                                                                       Name

                                                           _______________________________________________________________________

                                                                                                                                        Address

                                            Job Location                                                                            

                                  __________________________                                                    I

                                                                                                                                               I    Date approved___________________

                                  __________________________                                                    I

                                                                                                                                               I   ______________________________

                                                                                                                                                I              Town Clerk/Treasurer

                                                                                                                                                I  ______________________________

                                                                                                                                                I               Mayor

                                                                                                                                                 ______________________________                                                       

        STATE OF SOUTH CAROLINA/COUNTY OF CHARLESTON/TOWN OF MEGGETT

                                       

 I do solemnly swear that the statement made as to the gross income or other form of measurable return is true and correct, as reported on my South Carolina Tax Return for the year of 20______.

 

     Signature of applicant  _____________________________________________