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2. Business Name *
3. Webster Groves Street Address*
   Webster Groves, MO 63119
5. The above business is*
   -- Select One --a non-profit business.an exempt MO Statue 71.620 business.
7. The Business Ownership Has Changed*

   1. Yes

   1. No
8. This Business Makes Retail Sales *

   1. Yes

   1. No
10. Additional Information & Comments
12. First Name*
13. Last Name*
15. Please provide your phone number in case there are any questions about your submission.*
    Phone
16. Please provide your email in case there are any questions about your submission.*
    Email
18. By submitting this form you acknowledge that you are the owner/manager of the business listed above, and you are allowed to act on behalf of the business.*

    1. I hearby state and declare under penalty of perjury that the above is true and correct.
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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit Submit and Print

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