Are you a business owner who is looking to submit the Mississippi Form 297 E (Affidavit of Business Organization)? Completing this form can be complicated and time-consuming, leaving many business owners unsure where to start. In this blog post we will break down the details of what exactly the Mississippi Form 297 E requires, and provide you with step-by-step instructions for successfully submitting it. So whether you're starting out in Mississippi or expanding your operations across state lines, don't worry about feeling overwhelmed -- let us help guide you through filling out the Mississipi Form 297 E!
| Question | Answer |
|---|---|
| Form Name | Mississippi Form 297 E |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | Form297 mississipi form 297 e |
ApplicationforNewPermit
For Health Department Use Only
NameofFacility |
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FacilityIDNumber |
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PhysicalAddress |
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PINNumber |
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EnvironmentalistCode |
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City |
State |
Zip |
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MailingAddress (if different from physical address) |
FacilityPhoneNumber |
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PHPriority |
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City |
State |
Zip |
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FacilityManagerName |
Fax# |
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Owner is (check[✓] one): ❑ Association |
❑ Corporation |
❑ Individual |
❑ Partnership |
❑ Other ____________________ |
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OwnerName |
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Owner/Designee |
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Designee/ContactInfo |
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Address |
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PhoneNumber/Cell |
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CorporateSupervisor(if applicable) |
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Address |
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PhoneNumber |
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SmokeFree |
❑ Yes |
❑ No |
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Ihavereceivedacopy oftheMississippi StateDepartment of Health ______________________ andam familiarwith all
applicablesections. Ihavecompliedwith all requirements of this regulation. As owner/manageroftheabovefacility, I hereby request theMississippi StateDepartment ofHealth to makean inspection andto issueapermit to operatethe facility/business namedaboveandagreethat upon proper
identification arepresentativeoftheDepartment ofHealth may enterupon thesepremises andinto this facility/business forthepurposeofmaking official inspections and/orcollecting samples ifapplicableat any timethis facility/business is open forbusiness. It is furtherunderstoodthat, shouldapermit be issued, it may besuspendedorrevokedat any timeforjust cause, as determinedby theregulatory authority.
Applicant Name/Signature |
Date |
AddressEmail
PhoneNumber
ForHealthDepartmentUseOnly
ApplicationApprovedDate _______________________________________ |
Signature _____________________________ |
Facility is (check [✓] one): ❑ New ❑ Remodel ❑ Conversion |
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Plan ReviewApprovedDate ______________________________________ |
Signature _____________________________ |
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MississippiStateDepartmentofHealth |
Revised5/12/09 |
FormNo. 297E |