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❑ Mr. � Mrs. First Name M. I. Last Name <br />❑ Ms. ❑ _ CHERI BEDFORD <br />Title Primary Phone <br />V MAIN STREET MANAGER (903) 784 - 9293 Ext. <br />w Secondary Phone (optional) Fax (optional) <br />� ( ) - Ext. (903) 785 - 8591 Ext. <br />WE-mail address Would you prefer to be contacted by E-mail? <br />Vcbedford@paristexas.gov � Yes ❑ No <br />� <br />Address <br />135 S. E. 1 ST STREET <br />City State Zip County <br />PARIS TX 75460 LAMAR <br />The applicant, by and through its agent's signature below (1) certifies that all information provided in <br />connection with this application at any time is true and correct to the best of their knowledge; (2) <br />acknowledges that any misrepresentation or false statement made in connection with this application, <br />— whether intentional or not, will constitute grounds for denial, pursuant to this application and/or <br />�assessment of monetary administrative penalties. If signed by an agent (including employee) of the <br />� applicant, the person signing certifies that he or she is authorized to make the preceding certifications on <br />V behalf of the applicant. <br />w <br />N Chief Elected Official (type or print name) Title <br />ARJUMAND HASHMI MAYOR <br />Applicant Signature Date / / <br />month day year <br />2010 Main Street Application Page 8 of 30 2-5-10 <br />- - '7 5 <br />