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2. Business Name *
3. Webster Groves Street Address*
   Webster Groves, MO 63119
5. The above business is*
   -- Select One --closing.will no longer be operating within the city limits of Webster Groves.
7. Additional Information & Comments
9. Business Closing Date*
   Business Closing Date
11. First Name*
12. Last Name*
14. Please provide your contact information in case there are any questions about your submission.*
    Phone / Email
16. By submitting this form you acknowledge that you are the owner/manager of the business listed above, and you are allowed to act on behalf of the business.*

    1. I hearby state and declare under penalty of perjury that the above is true and correct.
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18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit Submit and Print

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