Recorder’s Office
Official Contact Information
(1) ___________________________________ _______________________
Name (Salutation, First, MI, Last, Suffix) Title
____________
_______ ___________________ ______________________
Phone #/ Ext (If Applicable) Fax # Email Address
(2)
___________________________________ _______________________
Name (Salutation, First, MI, Last, Suffix) Title
____________
_______ ___________________ ______________________
Phone #/ Ext (If Applicable) Fax # Email Address
Contractor Information
____________________________ _________________________
WV Contractor License # License Expiration Date:
Type of Contractor: _________________________________________________________
Contractor Responsible for: Its own B&O ONLY
Its own and subcontractors B&O
Business and Occupational Tax to be paid:
Quarterly By the Job
UNDER PENALTIES OF PERJURY, I declare, to the best of my knowledge and belief, that the information
submitted (including accompanying schedules and statements) IS TRUE, CORRECT AND COMPLETE
Preparer’s Signature Title Date
__________________________ ________________________ ______________
Email application and pay by phone: csypolt@townofgranvillewv.gov 304-599-5080 or
send check to Town of Granville PO Box 119 Granville, WV 26534
click to sign
signature
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