CRAIGHEAD COUNTY REGIONAL SOLID WASTE MANAGEMENT DISTRICT
1620 Strawfloor - P.O. Box 1997Jonesboro, AR 72403
870-972-6353
APPLICATION FOR WASTE HAULER LICENSEVEHICLE OWNER:_________________________________________________________________________________
ST./MAILING ADDRESS:___________________________________________________________________________ CITY, STATE, ZIP:_________________________________________________________________________________ PHONE:________________ CONTACT PERSON:________________________________________________________
Box for CCRSWMD
Use, Only
Decal Nos.
NAME OF BUSINESS:_______________________________________________________
TYPE OF BUSINESS:________________________________________________________
VEHICLES TO BE LICENSED (use additional sheets if needed):
1. MAKE YEAR MODEL
VIN TAG NO.
2. MAKE YEAR MODEL
VIN TAG NO.
3. MAKE YEAR MODEL
VIN TAG NO.
LICENSE FEE IS $25.00 PER VEHICLE. ATTACHED IS $ FOR (NUMBER) VEHICLES.
VEHICLE LIABILITY INSURANCE IS REQUIRED. PROOF OF INSURANCE FOR EACH VEHICLE IS ATTACHED. YES
I certify that the above information is correct and complete; and I understand that licensed vehicles are subject to random or special inspections; and I will correct any deficiencies noted during such inspections or be subject to penalties.
DATE:_____________________________
(Authorized Signature)
TITLE
Application must be post marked no later than January 31st to avoid penalty. Late penalty will double the initial cost ($50.00 per vehicle).
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