Town of Bremen Precious Metal Dealers Daily Report |
Seller/Purchaser Information: |
Name: _______________________________________________________________________ |
Address: _____________________________________________________________________ |
Date of birth: _________________________________________________________________ |
Drivers license number: ________________________________________________________ |
or |
Social security number: _________________________________________________________ |
Telephone number: ____________________________________________________________ |
Government issued photographic ID used to verity seller: |
_____________________________________________________________________________ |
Unique identification number on ID: ______________________________________________ |
Metal Dealer Information: |
Amount of consideration paid: ____________________________________________________ |
Description of each piece of precious metal bought or sold: |
(all precious metals must be photographed) |
_____________________________________________________________________________ |
_____________________________________________________________________________ |
_____________________________________________________________________________ |
_____________________________________________________________________________ |
Dealer Name: _________________________________________________________________ |
Dealer Address: _______________________________________________________________ |
Telephone number: _____________________________________________________________ |
(Ord. 3-2014, passed 2-24-2014)