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Page 5 of 5 Form L -ON <br />1 <br />This is to certify on this day of , 207" , the applicant holds or has applied <br />for and satisfies all legal requirements for the i an of a ales Tax Permit under the Limited Sales, Excise <br />and Use Tax Act or the applicant as of this da_ iis,�not required to hold a Sales Tax Permit. <br />j <br />Sales Tax Permit Number 0 603 `f &_24utlet Number 00 1 <br />Print Name of Comptroller Employee , <br />Print Title of Comptroller Employee <br />SIGN } 4� <br />HERE FIELD OFFICE <br />SEAL <br />�. 1. <br />Name of newspaper <br />_ City, County <br />Dates notice published in daily/weekly <br />newspaper (mm/dd/yZryy� <br />ATTACH PRINTED <br />Publisher or designee certifies attached notice was published in <br />newspaper stated on dates shown <br />COPY OF THE <br />NOTICE HERE <br />Signature of publisher or designee <br />1 Sworn to and subscribed <br />before me on this date <br />Signature of Nota Public <br />SEAL <br />Page 5 of 5 Form L -ON <br />