CITY OF BEREA
REQUEST TO CLOSE OCCUPATIONAL LICENSE ACCOUNT
212 CHESTNUT STREET BEREA, KY 40403 PHONE: 859-986-7218
Legal Business Name __________________________________________________________________________________________
DBA ________________________________________________________________________________________________________
Social Security or Federal tax ID Number: _______________________________________________________________
Date All Business Activity Ceased In City: _______________________________________________________________
Reason for Closure Request: _________________________________________________________________________
________________________________________________________________________________________________
Current Owner‘s Forwarding Address
Name: ______________________________________________________________________________________________________
Address: ____________________________________________________________________________________________________
City/State/Zip: ________________________________________________________________________________________________
Phone: _____________________________________________ Fax: ____________________________________________________
Email: ______________________________________________________________________________________________________
New Owner’s Information
Name: ______________________________________________________________________________________________________
Address: ____________________________________________________________________________________________________
City/State/Zip: ________________________________________________________________________________________________
Phone: __________________________________________ Fax: ________________________________________________________
Email: ______________________________________________________________________________________________________
I certify that all business activity has ceased within the city limits of Berea, Kentucky as of the date above. It is understood
that the closing of this account shall in no way relieve the owners of this business from any occupational license fees due
the city currently, or in the future, from being paid.
Authorized Signature: _________________________________ Title: ___________________________________ Date: ___________
PLEASE MAIL OR FAX TO:
CITY OF BEREA
FINANCE DEPARTMENT
212 CHESTNUT STREET
BEREA, KY 40403
FAX: (859) 986-7616
CITY OF BEREA, KENTUCKY
(859) 985-5869 - www.bereaky.gov
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