MADISON COUNTY BUSINESS LICENSE APPLICATION 
               
                                        FOR BUSINESS ACTIVITY IN THE UNINCOPORATED MADISON COUNTY ONLY 
                                           (Excludes business activities done within city limits of Richmond and Berea) 

BUSINESS NAME AND ADDRESS: 
                                                                      BUSINESS OWNER(S) 
_________________________________________ 

_________________________________________                             NAME: ____________________________                 

                                                                      ___________________________________ 
 _________________________________________ 
                                                                      ADDRESS:               
EMAIL ___________________________________                             ___________________________________ 

PHONE___________________________________                                               ___________________________ 

TYPE OF BUSINESS ACTIVITY__________________ 
                                                                      PHONE:____________________________ 

 MAILING ADDRESS: (if different than above) 

# OF EMPLOYEES WORKING IN COUNTY___________                           

FEDERAL TAX ID ______________________ 

 SOCIAL SECURITY#______________________   

I SWEAR UNDER PENALTY OF LAW THAT THE ABOVE INFORMATION IS TRUE AND CORRECT.  I MUST SEPARATELY COMPLY WITH ANY 
ZONING, FIRE MARSHALL, HEALTH, OR OTHER RULES. 
                                                                  
          __________________________________ __________        /      _____________________ 
                  SIGNATURE OF APPLICANT                                                                            DATE  

     REMITTANCE:  MAIL COMPLETED APPLICATION AND CHECK PAYABLE IN THE AMOUNT OF $10.00 
      
      TO: MADISON COUNTY FINANCE               OR                DROP IT OFF AT: 135 W. IRVINE ST 3 RDFLOOR  
              PO BOX 547                                                                       RICHMOND, KY 40475 
              RICHMOND[Type text] KY 40476-0547 
               
  PLEASE FEEL FREE TO CALL WITH ANY QUESTIONS OR CONCERNS 859-624-4742