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PLEASE LIST ALL PERSONS WHO WILL OCCUPY THE DWELLING UNIT:
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I/We hereby certify that I/we am the proposed occupant(s) and that the answers contained herein are true and accurate in all respects to the best of my/our knowledge and belief. I/we further certify that I/we understand that this is an APPLICATION ONLY and that it is unlawful for me/us to occupy said dwelling unit until an approved Occupancy Permit shall have been obtained from the City of Black Jack, Missouri
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OCCUPANCY PERMITS FEES MAY NOT BE REFUNDABLE
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Email all supporting documents to deputycourtclerk@cityofblackjack.com
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Driver's License Marriage License Birth Certificates Copy of lease if renting/leasing
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* indicates required fields.
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