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• • <br />. ^~ •' 1 <br />~-~~ • ~`~ <br />`~ ~ ~- <br />. ' ~° s ~ Tim <br />•:~• " . T~ecaa, 77255 <br />4 2501 ~ (P.O. Box 25240 ' <br />~hot'-e (713} 620-68T0 <br />{2} Typer Oxie r <br />.,{,1) Sst• Nor ^ ~~. ,.~ ~ ;• ~ ~ (~,} st~~_ {7) Zip ~ ~ <br />. •~4) St. Address / ~'"`~ ~' "City •• •~it %j~ {10) ~ ..,i <br />~~ r <br />~ ($~ Mai1~9 }~d~ea8 <br />.~~.~~ 12) District Dto.~ (l3) lncorp. Citiy 7'-~ <br />(11) Z'ip~ ~ { <br />{ 14} ;p~ell ar pL1~1 is W ,~, ~'~G+'~ { 15) StaCa xD# I . - '~ { 18) Non Progi,t. <br />. ~ . /~jrkr ~ X17) Fhone <br />{16) er' , ~,. • '• iii"' dzange of pwnerahip <br />:: -~• <br />A.. ClesB A ,' $125.00 <br />B. Glass B ' .,-,%/ f 50,00 l <br />l G. Cla~- C ; ..,% f -~' LS `$' 50.00 Paid - <br />-'~ p. 6naw•ConQ 9ra~ $100.00 p~ $ <br />r-' g. Sees~l p~gait (i20 date) $ 75.00 <br />,,, M~ f ` • ± •~9 <br />Receipt Na. <br />ter. ~. ++~+Y++~C'? ~ ~~.`~~ r ~ ~.D4 <br />--- permit t <br />,.. //~7) 'r For 19~.___~. <br />~~ Aunt Due ' . / --~ <br /> <br />l . • ~ I• f, •.~ ~, . <br />8ignatuce of F~nploy~ <br />Receivit~ _ ; <br />7' <br />.~ .• ~ pirate ny bus~.nasa~ _ <br />~ 8 S= ~ for a NTH PERMIT trhich is necessary s~wice and ~ladaii @'cod <br />In lryg ulations os- Food <br />pith Rules ar-c3 ~ t or o~ratian of my bu#~.nees. I <br />,~lerstand crud a5~ xo ooa~plY sled for <br />EQtablist~oanta end ~~ Laws that ~Y gpver<t ove+d <br />tha .failure to obtain a Health Perms ~~~i guiredt f pa~ymen ~ and <br />urtderstar-d is t. Y wi17. oit <br />operating withavt ~ by expiration date <br />applica~i,~ mithit~ seven (7) s~aY~+ <br />~ ~~ t ~ 1(1 <br />gignatu~ of ownerl~~''• Date. '~ 19 r <br />P p^~-249, ~'~ -+`•`"`. ~ DiVieian <br />Attentions gnvi~,nental wealth <br />.:, <br />rd;,aa. N.,.s <br />