RESTAURANT RETURN TO WORK
CONTACT INFORMATION
Business Name:
Contact First Name:
Contact Last Name:
Contact Email:
RESTAURANT INFORMATION
Restaurant Name:
Street Address:
Apt/Suite/Office:
Restaurant City:
Restaurant Zip Code:
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NAICS Code – found on 2019 Tax Return
Check each box if statement is accurate:
Restaurant is either full-service or limited service food and beverage establishment that operates predominately as and makes significant accommodations for on-premises, in-person dining
Offers on premises dining
The business is independently owned and operated
The business has fewer than 100 full-time equivalents as of April 1, 2021
The business is substantially in compliance with public health and emergency orders related to restaurants
The business does not owe past due state or local taxes, unless in binding agreement with taxing authority
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Q2 2019 & 2020 GROSS RECEIPTS AS SHOWN ON TAX RETURN
Q2 2019 Gross Receipts:
Q2 2020 Gross Receipts:
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Q3 2019 & 2020 GROSS RECEIPTS AS SHOWN ON TAX RETURN
Q3 2019 Gross Receipts:
Q3 2020 Gross Receipts:
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Q2 2019 PART-TIME & FULL-TIME EMPLOYEES
Q2 2019 Part-Time Employees:
Q2 2019 Full-Time Employees:
Q2 2020 PART-TIME & FULL-TIME EMPLOYEES
Q2 2020 Part-Time Employees:
Q2 2020 Full-Time Employees:
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Q3 2019 PART-TIME & FULL-TIME EMPLOYEES
Q3 2019 Part-Time Employees:
Q3 2019 Full-Time Employees:
Q3 2020 PART-TIME & FULL-TIME EMPLOYEES
Q3 2020 Part-Time Employees:
Q3 2020 Full-Time Employees:
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