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REQUIREMENTS FOR A COMMON VICTUALLER LICENSE 1. Common Victualler Application • If a corporation, must have a vote authorizing the application for a license • Must submit Certified Articles of Organization • If a partnership, must submit a partnership agreement • Business Certificate 2. Health Department Notification Form or a letter from the Health Department • Must be signed by the Health Department and submitted with the application 3. Routing Slip or Certificate of Inspection • Must be submitted with all signatures, prior to issuance of the license 4. If property is being leased • A signed copy of the lease must be submitted 5. Must be advertised for one day in the Salem News • This office will supply the notice for you to have published • Original advertisement must be submitted to this office 6. Abutters must be notified of the application • This office will supply you with a certified abutter’s list. Within three days of the publication, you must notify the abutters and provide to the City of Salem a certificate of mailing issued by the U.S. Postal Service. 7. A CORI form for each owner or partner must be completed to process the application. 8. $50.00 fee (calendar year) 9. Purchase & Sales Agreement (if applicable) 10. Floor Plan 11. Menu DOMINICK PANGALLO MAYOR CITY OF SALEM, MASSACHUSETTS LICENSING BOARD 93 WASHINGTON STREET 2nd FLOOR SALEM, MA 01970 TEL. [PHONE REDACTED] [EMAIL REDACTED] GARY M. BARRETT, Chairman DEBORAH A. GREEL, Member GARY F. SANTO, JR., Member SGT. MIKE BALL, Special Invest. MELISSA MOJICA, Clerk of the Board ---PAGE BREAK--- CITY OF SALEM COMMON VICTUALLER APPLICATION TO THE LICENSING BOARD: I, the undersigned, duly authorized by the concern herein mentioned, apply for a new/renewal common victualler license. 1. Name of Business: D/B/A 2. Address: Tele.#: Email address: (required) 3. Is the above concern an individual, co-partnership, an association or corporation? 4. If an individual, state full name, residential address, Soc. Sec. # and telephone number. If a co-partnership, state full names, residential addresses Soc. Sec. # and telephone numbers of persons composing it. 5. If an association or corporation, fill in the following paragraph. (Place an * before the name of each director) Name No. of shares Address Tele. # Name S.S.# President Name S.S.# Treasurer Name S.S.# Clerk Capacity (per Bldg Dept): Days & Hours of operation: NAME: RESIDENCE: CELL/HOME# PAYABLE TO THE CITY OF SALEM APPLICATIONS DUE BY DECEMBER 15th WITH A FEE OF $50.00 ABOVE STATEMENTS ARE MADE UNDER THE PENALTIES OF PERJURY