Form Eh Fp 003A PDF Details

In order to ensure the accuracy of your tax filings, it is important to use the correct form for your specific situation. Form Eh Fp 003A is used by taxpayers who are self-employed and have income from a single business venture. This form allows you to report your business income and expenses on a single document. By using this form, you can avoid potential penalties from the Internal Revenue Service (IRS). Be sure to familiarize yourself with the instructions for Form Eh Fp 003A before filing your return. The deadline for filing this form is April 15th.

QuestionAnswer
Form NameForm Eh Fp 003A
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesExpiration, Maryland, Applicant, falsification

Form Preview Example

Application fee is non-refundable
Type or print in black ink. All blanks must be filled in, if applicable, and the application must be signed. Send the application fee to the address above, in the form of a check or money order made payable to: "Prince George's County Health Department."
Check type of operation: Multiple Day Temporary Day Event $75.00
Single Day Temporary Event $75.00
Single Day Temporary Event $25.00 (If application is received 14 or more calendar days before the event)
Special Food Service Facility/Non-Profit Organization NO CHARGE (Must submit proof of non-profit status and booth must be staffed by members of the organization)
Incomplete applications will be returned for corrections/completion and will delay issuance of permit. Permits must be issued prior to preparation or sale of food.
If you need assistance filling out this application, please call 301-883-7690.
The permit application must be received at least (2) days prior to the event to guarantee inspection.
OPERATING WITHOUT A HEALTH DEPARTMENT PERMIT IS SUBJECT TO A $300.00 FINE.

TEMPORARY EVENT

Prince George’s County Health Department

Environmental Health

SPECIAL FOOD SERVICE FACILITY (Class II)

Largo Government Center | 9201 Basil Court, Suite 318

PERMIT APPLICATION

Largo, Maryland 20774-5310

 

Office 301-883-7690 | Fax 301-883-7601

PLEASE READ CAREFULLY

TDD for the hearing impaired 301-883-5025

INSTRUCTIONS

 

Trading Name or Organization

 

 

Applicant Phone Number

 

 

 

 

 

 

APPLICANT INFORMATION

Name of Applicant

 

 

Applicant Cell Phone Number

 

 

 

 

 

Applicant Mailing Address

Number

Street

 

 

 

 

 

 

 

 

 

City

State

Zip Code

 

 

 

 

 

 

 

Foods Being Served by Applicant

 

 

 

 

 

 

 

 

 

 

Name of Event

 

 

 

Event Date

EVENT INFORMATION

 

 

 

 

 

Event Address / Location

Number

Street

Setup Time

 

 

 

 

 

 

 

 

City

State

Zip Code

 

 

 

 

 

Event Coordinator/Contact Person

Daytime Phone No.

E-mail Address

 

 

 

 

SIGN

I have examined and read the above application and know the same is true and correct, and that in

operating a food service facility, I agree to comply with all applicable laws and regulations including,

but not limited to, the State of Maryland and Prince George's County.

 

PLEASE

I understand that falsification of this application may result in the denial, suspension or revocation

 

 

of the permit.

 

 

 

 

 

________________________________________

___________________________________________

 

Applicant Signature

 

Printed Name of Applicant

FOR OFFICE USE ONLY

Do Not Write Below This Line

Date of Approval

Receipt Number

Amount Received

Date Received

Facility Number

 

 

 

 

 

Approved By

Permit Number

Date Permit Issued

Expiration Date

 

 

 

 

 

 

EH-FP-003a (4/07)

How to Edit Form Eh Fp 003A Online for Free

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This PDF doc needs some specific information; in order to ensure accuracy, be sure to bear in mind the tips further down:

1. Start filling out the falsification with a selection of major blank fields. Consider all of the required information and ensure absolutely nothing is missed!

Stage number 1 for filling out applicable

2. Right after this selection of blank fields is completed, go to enter the applicable information in all these - Name of Applicant Applicant, Setup Time, City State Zip Code Event, Daytime Phone No, Email Address, cid I have examined and read the, operating a food service facility, cid I understand that, of the permit, Applicant Signature Printed Name, Do Not Write Below This Line, Date of Approval, Receipt Number, Amount Received, and Date Received.

Part no. 2 in submitting applicable

Be extremely attentive when filling out Date Received and of the permit, as this is where most users make errors.

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