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2. Business Name
4. Business Address
6. City
7. State
8. Zip Code
10. Mailing Address
12. City
13. State
14. Zip Code
16. General Information

    All permits for coin-operated amusement machines are payable annually in advance. Prior to the placement by an owner of a
    coin-operated amusement machine in operation at a location, there shall be attached thereto a valid City permit for the
    machine. Each coin-operated amusement machine is subject to the annual occupation tax when placed in operation in the City.
    The following permit fee will be applied to a coin-operated amusement machine which is placed in operation in the City:

18. 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.

20. INSTRUCTIONS FOR PREPARING MACHINE INVENTORY

    Attach to this form a complete list by make, model, serial number, and location of all the coin-operated amusement machines for which you are purchasing permits. Do not include coin-operated cigarette, service, and merchandise vending machines, or
    coin-operated amusement machines designed exclusively for children. Determine your total permit fee by multiplying the total number of machines by the $15.00 permit fee.

    With this application I am tendering the sum of $ for coin-operated amusement machine permits.

22. 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
24. Electronic Signature of Applicant - Owner
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27. 1. Receive an email copy of this form.
28. Email address

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