CITY OF OAK GROVE 
                                              P.O. BOX 250 
                                             OAK GROVE, KY 42262 
                                              Phone (270) 439-4646      
                                              Fax   (270) 439-1201        
 
                        APPLICATION FOR ADULT OCCUPATIONAL BUSINESS LICENSE 
                                             ORDINANCE NO.  2008-05 
 
APPLICANT INFORMATION 
 
NAME OF APPLICANT:          ____________________________________________________________________________ 
 
TRADE/STAGE NAME:           ____________________________________________________________________________ 
 
MAILING ADDRESS:            ____________________________________________________________________________  
 
CITY:                                        STATE:                                                                                            ZIP:                                      
                
TELEPHONE #                                                            
 
DATE OF BIRTH:                                                            DRIVERS LICENSE #:                                                                                          
 
ACCOUNTING PERIOD 
 
________Calendar Year____________Fiscal Year_____/________to______/_________(please specify beginning of year) 
 
                                             AMOUNT OF LICENSE FEE  
                            The minimum license fee due with this application is $100.00 
 
        No license will be issued to any entity or individual owing the City of Oak Grove delinquent taxes, Occupational or 
         Payroll withholding license fees, any other fees, taxes or assessments of any type. 
        Two proofs of ID are required, including a valid picture I.D. 
        Payments are required in CASH only. 
 
                           I hereby certify all information and statements herein are true and correct. 
                                                           
                                                                                                                                              OFFICIAL USE: 
         SIGNATURE:                                                                                                                            
                                                                                                                                              License # ____________________ 
         PRINT NAME:                                                                                                                           
                                                                                                                                              Invoice # ____________________ 
         DATE:                                                                                                                                                                       
                                                                                                                                              Date:       ____________________