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2. 

                                                      

   
   

   City of Mabank
   129 E Market Street, Mabank, TX 75147

   Phone: 903-887-3241                              

3. City of Mabank
   129 E Market Street, Mabank, TX 75147

   Phone: 903-887-3241                                

5. Business Name
7. Business Address
9. City
10. State
11. Zip Code
13. Mailing Address
15. City
16. State
17. Zip Code

19. Permit Fee: $15.00 per machine.

     Each coin-operated amusement machine shall be registered with the City by make, model, serial number, and location. A permit issued by the city shall be affixed to each such registered machine.

21. Electronic Signature Agreement

    I hereby make application for City of Mabank permit(s) for the coin-operated amusement machine(s) which are listed on the attached machine inventory. I hereby certify that all information submitted in this application is true and correct.

    1. I agree
23. Electronic Signature of Applicant - Owner
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26. 1. Receive an email copy of this form.
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