Mayors Permit

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Republic of the Philippines

Province of Nueva Ecija


Science City of Muoz
_________ New
_________ Renew

Date _________

APPLICATION FOR MAYORS PERMIT


Name:________________________________________
Address:______________________________________
NATURE OF BUSINESS ORGANIZATION
/Single Proprietorship
/Partnership

Civil Status: _______________


Citizenship: _______________
/Corporation

/Coop/NGO

Main Activity (Sector)


_____/Trader _____/Processor/Manufacturer __________/Service _________/Others
Line of Business: ________________________________________________________________
Location of Business: _____________________________________________________________
DTI Business Name Certification No.: ________________________________________________
Business Name: _________________________________________________________________
For New Application:
Capital Invested: _________________________________No. of Workers: __________________
For Renewal Application:
Last year Capital Invested: _________________________________________________________
Present Capitalization: _____________________________No. of Workers: __________________
Last Year Declared Gross Sales: ____________________________________________________
:
2nd Quarter
:
3rd Quarter
:
4th Quarter :
: Line of Business : 1st Quarter
: ______________: _____________:________________ :________________ :______________:
: ______________: _____________: _______________ : ________________ : _____________ :
: ______________: _____________: ________________ : ________________ : _____________ :
: TOTAL: _______: _____________: ________________ : ________________ : _____________:
This is to certify that the above are true and correct to the best of my knowledge and I hereby
agree to comply with the provision of the City. It is understood that any misinterpretation or false state
ment herein and violation of City Ordinances, Rules and Regulations are valid ground for the revoca
tion of the Mayors Permit.
ASSESSMENT:
Mayor s Permit
Health Certificate ________________________________
Sanitary Permit __________________________________
City License
City License ____________________________________
Tobacco _________________________________
Liquor
Regulatory Fee __________________________________
Service Fee _____________________________________
Garbage Fee ____________________________________
Fire Clearance ___________________________________
Surcharge/Penalties _______________________________
Weight and Measurement
Fixed Tax _______________________________________
Oath Fee ________________________________________
TOTAL __________________________________

Signature of Applicant
CTC No.
Issued on___________________
Issued at ___________________
Assessed By:

Received and Recommend by:


___________________________
LUZVIMINDA P. DE LEON
City Treasurer
Approved:
_____________________________
NESTOR L. ALVAREZ, Ph.D.
City Mayor

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