1762GOVERNMENT GAZETTE, WA 22 March 2017

1762 GOVERNMENT GAZETTE, WA 22 March 2017 apply for registration, for the year ended ................................................................................................... of ................................................................................................................................................................... (Location of Premises) being premises in or upon which there is (or is to be) carried on an offensive trade, namely— ....................................................................................................................................................................... (Description of Offensive Trade) under the business name of ......................................................................................................................... ....................................................................................................................................................................... .................................................................. (Signature of Applicant/s) .................................................................. (Date) The prescribed registration fee of $....................... is attached.