OFFICE OF THE
BOARD OF SELECTMEN
Town of Shrewsbury
MASSACHUSETTS 01545-5398
APPLICATION FOR LICENSE
Name of person filling out application: ______________________________________________________________
Address: ______________________________________________________________________________________
Telephone: __________________________________ Cell Phone: ________________________________________
Email Address: _________________________________________________________________________________
Name of corporation or establishment: _____________________________________________________________
d/b/a Name (if applicable): _______________________________________________________________________
Location:
______________________________________________________________________________________
Number & Street Tax Plate Plot Number
I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and
paid all state taxes required under law.
__________________________________
__________
___________________________________________
* Signature of Individual or Corporate Name By: Corporate Officer
(Mandatory) (Mandatory, if applicable)
____________________________________________ ___________________________________________
** Federal Identification Number Date: (mm/dd/year)
* This license will not be issued unless this certification clause is signed by the applicant.
** Your Federal Identification number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax
payment obligation. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation.
This request is made under the
authority of Mass. G.L. c. 62C s. 49A.
** FOR OFFICIAL USE ONLY **
This application has been
APPROVED DENIED
Da
te: ________________________ ________________________________
SHREWSBURY LICENSING AUTHORITY
Richard D. Carney
Municipal Office Building
100 Maple Avenue
Voice: 508-841-8504
Fax: 508-842-0587
selectmen@shrewsburyma.gov
$150 Application Fee for NEW License includes Legal Advertisement and Abut
ter Notification (if alcohol related)
$125 Application Fee for NEW License includes Legal Advertisement and Abutter Notification (if NOT alcohol related)
Renewal Fees vary by license type.
Type of License
Alcohol (All Alcoholic Beverages)
Alcohol (Wine & Malt)
Club License
Common Victualer
Class 1 , 2 , 3 (specify)________
Garage
Dealer in Precious Metals
Entertainment
Other
Automatic Amusement (Each Device)
Billiards ( Each Table)
Theater Scre
en (Each Screen)
Bowling Alley (Each Lane)
Sunday Entertainment
Livery
Hours of Operation:
Sun________________
Mon_______________
Tue_______________
_
Wed_______________
Thu________________
Fri________________
Sat________________
Owner of Land:
CHECK ALL THAT APPLY
Amendment
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