206 S. Main St. Brighton, IL 62012 * 618-372-8860 (phone)
ALL persons, both principals and agents, as well as employers and employees, who sell, offer for or expose for sale, or who shall trade, deal or traffic in any personal property or services in the Village by going from house to house or from place to place or by indiscriminately approaching individuals must apply individually for a peddler’s permit. (Ord. 186, 5-3-1948)
Non-Refundable Daily Fee $45.00 (or) Annual Fee $250.00
Applicant must present Current State ID with Picture AND Employer ID
Applying as: Employee Employer Principal
(Each employer/principals must also complete supplemental form.)
Village of Brighton Peddler #: 20_____-___________
This is an APPLICATION ONLY, and NOT a permit to conduct business.
Business Name: | Applicants Home Address: | |
Applicants Legal Name: | ||
Date Of Birth: ________/__________/_________ | All correspondence will be mailed to this address: Business Address: Check if same Home | |
Social Security #: ________-__________-__________ | ||
Drivers License #: | Email Address: | |
Business Phone: Cell Phone: | Date Requested for License: | |
Height:_______ Weight:________ Age:__________ Hair Color:_________ Eye Color:_________ | Description of Nature of Business: | |
Indicate Ownership Corporation Non-profit (Exempt) Status: Sole Proprietor Partnership | Goods or services to be sold: | |
Business will be conducted: Door to Door Other_____ Set Location/Address: ____________________________ | All sales to occur only on the requested license date & between the hours of 9:00 a.m. - 6:00 p.m. | |
If employed or acting as an agent, the name, address and phone number of the employer(s) or principal(s) with the exact relationship with the principal or employer: Name Address Phone # Relationship to Applicant (Each employer and/or principal must also apply separately and complete supplemental form.) | ||
Will a vehicle be used? No Yes | If yes | Plate #: Make: Model: Color: |
Has applicant (includes application by employer and/or principal) been convicted of any crime within the lest ten years, including misdemeanors, gross misdemeanors, or violations of any municipal ordinance? No Yes, If yes list the nature of the offense, and the punishment or penalty assessed. | ||
I hereby certify and declare under penalty of perjury under Illinois law that the statements furnished by me on this application are true and complete to the best of my knowledge and that I will comply with the provisions of the Village of Brighton. I understand that the Village may conduct a background check and any untrue statement is cause for revocation of my permit. Date ____________ Signature ______________________________ (Printed) ________________________________ STATE OF ILLINOIS COUNTY OF MACOUPIN I certify that I know or have satisfactory evidence that __________________________signed this instrument and acknowledged it to be his/her/their free and voluntary act for the uses and purposes mentioned in the instrument. ___________________________________________________ Notary Public Signature Notary (Print) _______________________________________ My appointment expires: ______________________ Dated: ____________________ | ||
Permit Supplemental Form for Employers and Principals
Applying as: Employer Principal | Business Name:______________________ Business Phone#:_____________________ Cell Phone#: ________________________ Email: _____________________________ | Business Address: |
FIN# _______________________________________________ | ||
All Employees and Agents Applying for Peddler Permit | ||
Employee Name | Employee Address | Employee Cell Phone |
Manager(s) for applicant(s) conducting business in Renton: | ||
Name: | Address: | Business Phone: _______________ Home Phone: _________________ Email: ______________________ |
Ownership of Business: Sole Proprietor Partnership Corporation Non-profit (Exempt) If a Corporation or Partnership, provide name, address and phone number of Board of Directors, principal officers, registered agents, and/or partners. (Attach additional sheet if additional room is needed) | ||
Name/Title | Address | Telephone# |
Has any of the above been convicted of any crime within the last ten years, including misdemeanors, gross misdemeanors, or violations of any municipal ordinance? No
Yes, If yes list name/title, nature of the offense, and the punishment or penalty assessed. |
Please list other cities, towns and countries where the applicant has obtained a peddler’s permit or similar permit within the past five years: |
I hereby certify and declare under penalty of perjury under Illinois law that the statements furnished by me on this application are true and complete to the best of my knowledge and that I will comply with the provisions of the Village of Brighton. I understand that the Village may conduct a background check and any untrue statement is cause for revocation of my permit. Date ______________ Signature _____________________________ (Printed) __________________________________ STATE OF ILLINOIS ) COUNTY OF MACOUPIN ) Signed and sworn to (or affirmed) before me on ____________________________ by ___________________________. ___________________________________________________ Notary Public Signature Notary (Print) _______________________________________ My appointment expires:________________________________ Dated: ____________ Permit can be picked up from the Village Clerks Office between the hours of 8:00 a.m.- 4:00p.m. Permit must be carried and displayed. Any person violating any of the provisions shall be fined not less than $50.00 nor more than $750.00 for each offense, and a separate offense shall be deemed committed on each day during or on which a violation occurs or continues. (Ord. 186, 1948; amd. 2002 Code) |
(Ord. 186, passed - -1948)