Mobile Home License

2. 

4. 807 Mountain Avenue | PO Box 1229 | Berthoud, CO 80513 | O: 970-344-5801 | E: deputyclerk@berthoud.org

6. Date of Application:
   Date of Application:
8. Company Name:
9. Email Address*
11. Address
13. City
14. State
15. Zip Code
17. Phone Number
19. Owner of Business:
21. Name
22. Email Address
24. Mailing Address

    Mailing Address if different from the above.

26. City
27. State
28. Zip Code
30. Attached Proof of Certificate of Insurance:*

    Must not be expired.

32. Attach Colorado Department of Revenue Sales and Use Tax License:*
34. $5.00 per Space

    Put how many spaces.

35. Total:

    Put the total here.

36. See Berthoud Municipal Code 14.5-2 and 14.5-3

    Application Fee: $5.00 per space payable to the Town of Berthoud by check or phone at 970-344-5801.

    The license expires every year on December 31.

Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit Submit and Print

* indicates a required field