OFFICE OF THE TOWN CLERK
One Washington Street Hempstead, NY 11550
Tel: (516) 812-3025 email: licensing@tohmail.org
GOING OUT OF BUSINESS SALES
PLEASE COMPLETE THE FOLLOWING INFORMATION IF THIS APPLICATION IS FOR A CORPORATION
ASSOCIATION, PARTNERSHIP OR AN INDIVIDUAL OWNER USING A TRADE NAME
GIVE THE NAME AND ADDRESS OF THE PERSON OR PERSONS IN CHARGE AND RESPONSIBLE FOR CONDUCT OF THIS SALE
Name of applicant: Start date of sale: End date of sale:
Address: Name of true owner of goods to be sold:
Town:
Owner of Business:
Date of incorporation or
organization:
Place of Incorporation or
Organization:
Trade, corporation or
association name:
Has the controlling interest in this corporation been transferred within Six (6) months prior to the date of this application ?
Zip Code: Descriptive Name of sale:
Wares or Merchandise to be sold:
Type of Sale:
20
20
Name of person in charge: Name of person in charge:
Address: Address:
Town:
Street address at which
sale will be conducted:
Length of time in business
at this location conducted:
Zip Code:
Zip Code:
Town:
Zip Code:
Reason for sale:
Effective date of
termination of occupancy:
Type of occupancy:
Office Use Only
APP. #
FEE PAID
DATE
LICENSE #
ISSUED
Business will be terminated permanently Business will be resumed
Leased
Owned
YES NO
Individual owner:
Partner: Corporation or association:
Closing out sale Application date must be at least 15 days
Defunct business sale Before date sale is to start
Sale of goods damaged by Smoke, Fire, Water or otherwise
}
Sworn to before me this
Day of 20
NOTARY PUBLIC
Signature of Applicant
Title
Rev. 12/17
Partner or
President
Partner or
Vice President
Partner or
Secretary
Name Address
Town:
Name or designation under which business will be resumed:
Street address or premise at which business will be resumed:
Value of inventory over
90 days old
Value of inventory less than
90 days old
Total value of inventory
Disposition of business upon termination of Closing Out Sale or Defunct business sale:
I solemnly swear to the truth of the above statements
click to sign
signature
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