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FI230 (2/2006)1. Check one:2. Check one:FOOD SERVICE LICENSE APPLICATIONFixed EstablishmentRenewal License ApplicationMobileNew Owner Mobile Commissary Est. Or New LocationVending Location: # of machines
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i certify that this is a statement confirming that the information provided is true and accurate to the best of the signer's knowledge.
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The information reported on i certify that this typically includes a statement affirming the accuracy of the information provided in the accompanying document.
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