Business Closure Form

All business licenses expire on December 31st of each year. If submitting a statement of closure after a new licensing period begins on January 1st of each year, you may be responsible for any outstanding charges on your account.

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Consent for storing submitted data *

• Yes, I give permission to store and process my data
• No, I don’t consent to storing and processing my data

Legal Business Name/DBA *

Business License #

Business Physical Address: *

Contact Phone Number *

Email Address *

Mailing Address

What was the last date of operation for the business? *

Please check the box next to the reason for closure. *

• Business entity dissolved, business no longer exists
• Business moved outside of Little Rock city limits
• Owner is deceased
• Business sold
• Impacted by Covid-19
• Other

Details

If the business was sold, please provide the new owner’s name and phone number. If you selected other, please provide details below.

well Name December

All business licenses expire on December 31st of each year. If submitting a statement of closure after a new licensing period begins on January 1st of each year, you may be responsible for any outstanding charges on your account for the current year, as well as any previous years outstanding balances *

• I agree

(If you do not agree we can not accept your online submission)

Name *

First

Last

Owner or Representative Phone Number *

Date *

Submit