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2. Corporate Name:
4. D/B/A Name:
6. Owner or President:
8. Manager:
10. Establishment Address:
12. Mailing Address:
14. Phone Number:
15. Email Address:
17. Choose Each License that Applies:

    1. Auctioneer - $25.00
    2. Automatic Amusement - $60 each
    3. Car Dealership Class I - $100
    4. Car Dealership Class II - $100
    5. Club License All Alcohol - $1,000
    6. Common Victualler - $60
    7. Common Victualler All Alcohol - $1,400
    8. Entertainment - $60 each
    9. Retail Package All Alcohol - $1,200
    10. Retail Package Wine/Malt - $1,200
    11. Sunday Package Store Opening - $25
19. Total Due:

23. Pursuant to M.G.L. Chapter 62C, s. 49A, I certify under the penalties of perjury that I have, to my best knowledge and belief, complied with the law of the Commonwealth relating to taxes, reporting of employees and contractors, and withholding and remitting child support.

    Pursuant to M.G.L. Chapter 152, s. 25A, I certify under the penalties of perjury that I have, to my best knowledge and belief, complied with the law of the Commonwealth relating to Worker’s Compensation Insurance.

    The application must be completed and electronically signed by the Manager, Owner or President. 

    This application along with any other required forms and payment must be received before the deadline on Monday, November 24, 2025. Payment is not accepted online at this time. Please mail a check or submit your payment in person at the Select Board Office at the Marion Town House Annex at 14 Barnabas Road. 

    
    

29. Electronic Signature:
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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

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