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Get Harris County Coin Operated Machine Permit

Hysical Address: (No P.O. Boxes) City: State: Zip: Daytime Phone: Permits Requested Please complete the information below, indicating each location for which a permit is requested. # PERMITS MACHINE TYPE LOCATION NAME LOCATION ADDRESS ZIP CODE I declare under penalties prescribed by the general and specific laws of Texas that the information provided herein are true and correct. Signature: Date: Printed Name: Title: Total Permits: Permit purchased between: Fee: January 1st - March.

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