HomeMy WebLinkAbout2011TOWN OF SOUTHOLD
E. NEVILLE, TOWN CLERK
PO BOX 1179
SOUTHOLD
NY 11971
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
FOOD CONTROL. SUITE 2A
360 YAPHANK AVENUE
YAPHANK. NY 11980
]'HIS tS YOUR BILL FOR RENEWAL OF YOUR FOOD ESTABLISHMENT PERMIT.
YOU MOST PROVIDE YOUR TAX IDENTIFICATION NUMBER AND SIGN THIS BILL
IN ORDER TO RECEIVE YOUR PERMIT.
~*** NOTE *~** YOUR PERMIT EXPIRES 12/51,
ENTER TAX NUI~BE, R: 11-6001939 SIGNATURE
MAKE CHECK: PAYABLE TO THE COMMISSIONER
/6/11
SOUTHOLt) HUMAN RES~ CTR.
PERMIT EXPIRES 12/51/11
YOUR-FEE IS
MARK HERE IF N~W OWNER OR
PO BOX 117~
SOUTHOLD
NY 11~71
TOWN .CLERK
~ "X" IF CHANGE OFADDRESS
ADDRESS CHANGE REQUESTED
~SUFFOLK COUNTY
DEPARTMENT OF HEALTH SERVICES
FOOD CONTROL, SUITE 2A
360 YAPHANK AVENUE
YAPHANK NY 11980-9645