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Form

Business Licence Cancellation Form

LICENCE INFORMATION

Licensee Name:

Licence Number:

Business End Date:

Reason for Licence Cancellation:

I hereby certify the information contained in this application to be true and I hereby make application to the City of Lloydminster to cancel the above-noted license under Bylaw 26-2023 as amended in accordance with this application.

Applicant Name:

Position:

Applicant Signature:

Clear

Date: