Blair Pawn 2017"Application for Occupation License"
City of Blair
218 S. 16th Street
Blair, NE 68008
,6
1$48, (402) 426 4191
The filing of this application or the granting of an occupation license neither confirms nor denies the use of the land as regulated under the provisions of the zoning
code, and is further subject to pertinent ordinances of the City of Blair which regulates and licenses specific affections and businesses.
Date: 17- i S/&
Business Information:
Legal Name of Business Blair Pawn
Common Name of Business
Business Address _1647 Washington St. City _Blair
Phone �2�,_ zzf y Fax 1& -ye- Legal Description
State _NE_ Zip _68008_
Lot 10, block 46
Mailing Address (if different from above) 5/r M City
Describe the nature of your business Pawn Shop
State Zip
Do you have a monitored Security and/or Fire Alarm System at the business address? Yes z No
Will you be selling tobacco products at this business address? Yes No
Do you have music, vending, pinball machines or billiard/pool tables at this business? Yes No
Do you sell, or serve liquor at this address? Yes No
Primary Contact Name: IonuC- 14rf M 6�2 Phone L(Z6 -Zz7V Birthdate 3 /3X-" t
Secondary Contact Name: kfi-4- 1eIM---P-� Phone Birthdate & (Z2`&/
I declare under penalty of false statement that to the best of my knowledge and belief the statements made
herein are correct and true.
Signature of Owner or Corporation Agent/Owner i'� Title �w�z
OCCUPATION LICENSE REMITTANCE FEE
I hereby remit $ This is based on Section 10-902 of the Blair Municipal Code
Date Paid: I Amount Paid: I Certificate # Assigned:
Western Surety Company
CONTINUATION CERTIFICATE
Western Surety Company hereby continues in force Bond No. 15084261 briefly
described as PAWN SHOP CITY OF BLAIR
for PAUL HAMER DBA BLAIR PAWN SHOP
, as Principal,
in the sum of $ FIVE THOUSAND AND NO/ 100 Dollars, for the term beginning
December 31 , 2016 , and ending December 31 , 2017 , subject to all
the covenants and conditions of the original bond referred to above.
This continuation is issued upon the express condition that the liability of Western Surety Company
under said Bond and this and all continuations thereof shall not be cumulative and shall in no event exceed
the total sum above written.
Dated this 30 day of
November 2016
WESTERN URETY COMPANY
7.
By
Paul T. Br at, Vice President
THIS "Continuation Certificate" MUST BE FILED WITH THE ABOVE BOND.
Form 90-A-8-2012