2. Closing Business Information

   Please enter information about the business that is ceasing operations in Kenton County.

4. Account Number*
5. Federal Tax Number/EIN/SSN*
7. Name of Business*
9. DBA*
11. Address*
13. City*
14. State*
15. Zip Code*
17. Date Activity Ceased in Kenton County*
    Date Activity Ceased in Kenton County
18. Reason for Closure*

    Please provide brief explanation of why business is closing

19. Did you sell this business?*

    1. Yes
    2. No
23. Name of New Owner*
25. Address of New Owner*
27. City of New Owner*
28. State of New Owner*
29. Zip Code of New Owner*
33. Your Contact Information

    Please provide contact information so that we can follow up with any questions. 

35. Your Name*
36. Your Title*
38. Your Phone Number*
39. Your Email Address*
40. Date Submitted*
    Date Submitted
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field