Noodle Registration 2013.tif ,
} CITY OF BLAIR FOR OFFICE USE ONLY
p _ 218 S 16TH STREET
BLAIR, NE 68008 Date Paid:
402) 426 - 4191 Receipt No: ''7 S �a
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Date Issued:
FAX (402) 426 - 4195
fo s co Email: cityofblair @ci.blair.ne.us BOND EXPIRES
CONTRACTOR REGISTRATION / LICENSE RENEWAL
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Please verify and correct
the company /business
Noodle Koodle of Cool Dads, _Inc._. -- ___..�� - -__m __
' information listed here:
Q,IIrn A+Mrt�
j Blair, NE 6800
Phone numbers on record:
Type: Phone Number: Type: Phone Number:
Mobile 402 278 0151 Office
Office
Email Address: Id1 so nd�cl�koo9k inn
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Type of Business: General
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
Brehm, Jeff General Certificate of Liability 8/29/2013
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Place a check in the box next to the licenses you wish to renew:
Renew? ,r Name License / Registration Expires Amount
rug
Brehm, Jeff General Contractor 12/31/2012 $60
Please list any additional license or registrations:
Name License / Registration Amount
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All information contained in this application is true and correct. I will notify the City of Blair of any changes in the
information reported on or with this application form within 15 days of change.
I hereby make application to the Licensing Board of Blair, Nebraska and certify that I am competent and experienced to
engage in above said vocation. I agree to conform strictly to the Ordinances of the City of Blair, Nebraska relative to said
voc t n a�d bey all order, r quirements and regulations of its lawful constituted authorities.
Ayll d Si ature Date
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