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Registered Consent Form
Which any process, notice, or demand required or
permitted by law or under said Ordinance to be served upon the licensee or owner may be served.
This
day of
, 20
.
Signature of Agent
Print Name of Agent
Print Agent's Street Address
Print Agent's City
-
County
-
State
-
Zip Code
Agent's Phone Number
APPROVED:
Sole Owner / Partner
Officer or Director
Title
*Note: Naming a Registered Agent is optional under the Consolidated Alcohol Ordinance of Dawson County.
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