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Get and Sign Food Service License Application State of Michigan 2006 Form
Route)
April 30, 2015
License No.
L2000ID
6. Applicant Information - MUST BE COMPLETED
I certify that this information is accurate
Signature
Date
City
State
X
Zip Code
Printed name of owner or authorized agent
3. Business & Owner Information
Name of Establishment or Business (type or print)
Title
E-Mail
Establishment Address (Number & Street, Box or Route)
Establishment Phone No.
Home Phone No.
City
Fax No.
Emergency Phone No.
Zip
County of Location
Name of Owner (First, MI,...
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