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�U �cT cJ CITY OF STOCKTON Stockton <br /> �- P 0 BOX 1570 A" <br /> Business License Number STOCKTON, CA 95201-1570 11111 ,III <br /> 7 7 S7 2004 <br /> Control Number 1999 <br /> CITY OF , <br /> STOCKTON <br /> Declaration of Closure of Business In The City of Stockton <br /> u, hereby declare as follows: <br /> Print Full Name <br /> I was owner of the business operating under the name of: <br /> Print Name of Business <br /> Located at: <br /> Print Business Addre s, City, Statq. 9kid Zip Code <br /> The purpose of the business was: <br /> This business enterprise is no longer operating in the City of Stockton, and has not since, <br /> T <br /> Month / Day I Year peratlons Ceased U <br /> 1 <br /> �1� � ed if <br /> 11 nder5tand that I may be prosecuted <br /> I make these declarations under penalty ofp <br /> these declarations are found to be untrue. 11 <br /> � !1�'1!�"' Date Slgned <br /> Owner or Authorize Agent Signature <br /> Print Your Address, City, State, and Zip Code <br /> Print Your Mailing Address, City, State, and Zip Code, If Different Than Above <br /> Area CodePhone Number <br /> BELOW THIS LINE FOR CITY USE ONLY / r <br /> 141L-' C2 ! �/-� <br /> Date <br /> Date eceived Signature of Staff Person Inactivating Business License <br /> Revised 4//114//06 Q <br /> d v' <br />