OFFICE OF THE TOWN CLERK
One Washington Street Hempstead, NY 11550
Tel: (516) 812-3025 email: licensing@tohmail.org
LICENSE RENEWAL APPLICATION
GOING OUT OF BUSINESS SALES
Name of applicant:
Address:
Town:
Zip code:
I certify that the goods, wares or Merchandise listed in the inventory dated ................... under the above license number have not been
disposed of and no new goods, wares and merchandise have or will be added to the inventory previously filed, pursuant to ARTICLE 29E
GOING OUT OF BUSINESS SALES OF THE GENERAL BUSINESS LAW, by purchase, acquistion consignment or otherwise.
Renewal application date:
License number:
Type of sale
License expiration date:
20
Office Use Only
APP. #
FEE PAID
DATE
ISSUED
Closing out sale Defunct business sale
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. 12-14
I solemnly swear to the truth of the above statements
OFFICE OF THE TOWN CLERK
One Washington Street Hempstead, NY 11550
Tel: (516) 812-3025 email: licensing@tohmail.org
NOTICE OF SALE TERMINATION
GOING OUT OF BUSINESS SALES
Name of licensee:
Address:
Town:
Name of transferee:
Type of business:
Town: Zip code:
Street address:
This notice must be filed with the Town Clerk of the Town of Hemsptead within Thirty Days of the termination date of the sale which was
conducted under the above license number.
Zip code:
Date of notice: Sale license #:
Retail value of goods not disposed of during sale:
Disposition of goods not disposed of during sale:
Sale termination date:
Sworn to before me this
Day of
20
NOTARY PUBLIC
Signature of Applicant
Title
Rev. 12-14
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