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LICENSE NO. APPLICATION FOR LICENSE TO CONDUCT REMOVAL CLOSING-OUT, FIRE, LIQUIDATION SALE Act 39 Public Acts of 1961 An Act to regulate insurance, bankruptcy, mortgage, insolvent, assignee’s, executor’s, administrator’s. receiver’s, trustee’s, removal and closing out sales, and sales of goods, wares and merchandise damaged by fire, smoke, water or otherwise; to provide penalties for the violation hereof; and to repeal certain acts and parts of acts. LOCATION OF BUSINESS NAME OF APPLICANT ADDRESS OF APPLICANT Phone No. Is the applicant the owner of the goods to be sold? If applicant is a partnership, corporation, firm or association, list the name and position of the individual filing such application. How long has applicant been in business at this location? Name and style in which such sale is to be conducted Address where sale is to be conducted The date and period of time over which such sale is proposed to be conducted Name and address of person in charge of and responsible for the conduct of the sale: Phone No. Type of Sale Reason for Sale Closing Out Sale – Applicant to state that the business will be discontinued at the termination of the sale. Removal Sale – Applicant to state that the business will be discontinued at the termination of the sale, and location of premises to which the business is to be moved. Fire, Smoke, Water, or otherwise Sale, Goods Damaged – Applicant to state time, location, and cause of damage. Has applicant ever received a license to conduct removal, closing out, fire, or liquidation sale before? If so, when and where? ---PAGE BREAK--- Applicant further represents that attached hereto is a full, detailed and complete inventory of the goods that are to be sold, which inventory shows: 1. Itemized list of the goods to be sold and good and sufficient information concerning each item, including make and brand name, if any, to clearly identify it. 2. Lists separately any goods which were purchased during a 60 day period immediately prior to the date of making application for this license. 3. The cost price of each item in the inventory, together with the name and address of the seller of the items to the applicant, the date of the purchase, the date of the delivery of each item to applicant and the total value of the inventory at cost. 4. A statement that no goods will be added to the inventory after the application is made or during the sale and that the inventory contains no goods received on consignment. Date of Application: Signature of Applicant Subscribed and sworn to before me this day of , 20 . Notary Public, Midland County, Michigan My Commission Expires: