If you're a business owner or tax preparer, you may be familiar with the DEQ Form 641 581. This form is used to apply for and certify an exemption from the Oregon Liquor Control Commission (OLCC) excise tax. In this blog post, we'll provide an overview of the DEQ Form 641 581 and explain how to complete it. We'll also discuss the benefits of certification and what happens if your application is denied. Let's get started!
| Question | Answer |
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| Form Name | Deq Form 641 581Cert |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | 641 581sp form, oklahoma deq 641, deq form 641, form 641581 |
ENVIRONMENTAL COMPLAINTS AND LOCAL SERVICES DIVISION
CERTIFICATION DOCUMENTATION FORM
Work Order No.
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System No. |
(PLEASE PRINT OR TYPE) |
Date Rec’d |
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GENERAL INFORMATION:
Name and Mailing Address of Property Owner:
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First Name |
Last Name |
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Street Address |
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City |
Zip Code |
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Owner’s |
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Property Address: |
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, Oklahoma |
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Street Address |
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City |
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Zip Code |
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County |
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Legal Description: |
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Lot Size in: |
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ft2, or |
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acres |
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Finding Location:
(Blocks or miles from a given point)
Please check the applicable certification that applies and sign below.
FLOW CERTIFICATION:
27A O.S. Section
This individual sewage treatment system will serve an individual residence or duplex with the following # of
bedrooms: .
The estimated flow or actual flow for this small public sewage system is |
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gal/day and is a |
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Type of Facility |
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I hereby certify under penalty of law that this document contains no willful or negligent misrepresentation or falsification and that all information is true, accurate and complete.
Print First Name |
Last Name |
Signature |
Date Signed |
Revised 4/30/2010 |
DEQ Form |