APPENDIX A: APPLICATION FOR SECONDHAND PRECIOUS METAL BUSINESS LICENSE
   The undersigned applicant for a license to operate a secondhand precious metal business, being first duly sworn, says that the answers to the following questions are true of his or her own knowledge and are made for the purpose of qualifying for the issuance of a secondhand precious metal business license.
1. NAME OF BUSINESS: __________________________________________
2. LOCATION(S) OF BUSINESS: __________________________________________________
______________________________________________________________________________
3. TELEPHONE NO. OF APPLICANT:
      Home __________________      Business ________________________
3.  This business is owned by an Individual ___; Partnership ___; Corporation ___; If Partnership or Corporation list name and address.
______________________________________________________________________________
______________________________________________________________________________
List the names, addresses, ages, physical description, North Carolina driver’s licenses, and social security numbers* for the owners of this business: (For partnerships, list all persons having an interest in the partnership; for corporations list all stockholders owning 10% or more of the corporation’s common stock.)
*THE DISCLOSURE OF SOCIAL SECURITY NUMBERS IS VOLUNTARY AND REQUESTED PURSUANT TO THE DALLAS CODE OF ORDINANCE. SOCIAL SECURITY NUMBERS WILL BE USED FOR IDENTIFICATION PURPOSES ONLY.
a.   NAME _____________________   SOC. SEC ___________
   ADDRESS: ___________________________________________________________
   AGE: _____ HEIGHT: ____   WEIGHT: ______ HAIR COLOR: _____
   EYE COLOR: _______.
   DRIVER’S LICENCE NO.: ____________   DATE OF BIRTH: ____________
b.   NAME _____________________   SOC. SEC ____________
   ADDRESS:____________________________________________________________
   AGE: _____  HEIGHT: ____ WEIGHT: ______ HAIR COLOR: _____
   EYE COLOR: _______.
   DRIVER’S LICENCE NO.: _____________  DATE OF BIRTH: _____________
c.   NAME ____________________   SOC. SEC _______________
   ADDRESS:_____________________________________________________________
   AGE: _____ HEIGHT: _____WEIGHT: ______ HAIR COLOR: _____
   EYE COLOR: __________
   DRIVER’S LICENCE NO.: ___________   DATE OF BIRTH: __________
d.   NAME ______________________   SOC. SEC ________________
   ADDRESS: _____________________________________________________________
   AGE: _____ HEIGHT: _____ WEIGHT: ______ HAIR COLOR: _____
   EYE COLOR:
   DRIVER’S LICENCE NO.: __________   DATE OF BIRTH: ___________
(List additional names on a separate sheet.)
5. Has any person listed above ever been convicted of any felony or of a crime involving fraud, thefts or receiving or possessing stolen property in the five (5) years immediately preceding the date of the license application ?
YES ___   NO____
IF YES, ATTACH LIST SHOWING NATURE OF OFFENSE, DATE OF OFFENSE, PUNISHMENT OR PENALTY AND GOVERNMENTAL UNIT INVOLVED.
6. Does the applicant have the necessary licenses from the state, federal and/or county governmental units?
   YES ____    NO _____   IF YES, ATTACH COPY(S).
7. Other requirements to be met:
a. All owners and employees must have their fingerprints and photographs taken by the Dallas Police Department.
Every new employee must provide, within five (5) days of being employed, name and address to the Dallas Police Department and be fingerprinted and photographed by the department.
b. Complete records of all transactions with a non-licensee must be kept by secondhand precious metal businesses Including a description of the items involved the date of transaction, the name, address, description and identification card information of the person involved. The records shall be kept in a tightly bound book with pages numbered sequentially, and a copy of the records shall be filed with the Dallas Police Department with forty-eight (48) hours of the transaction.
c. All secondhand articles made of gold, silver or platinum shall be open to inspection by law enforcement officers at reasonable times for a period of five (5) days after the purchase or acquisition.
d. No business shall purchase a gold, silver or platinum article from a juvenile under eighteen (18) years of age, without written consent of the juvenile’s parent or guardian or presentation of proof of ownership.
e.    An annual privilege license as prescribed by the Board of Aldermen, shall be paid in order to conduct in the Town of Dallas.
IF APPLICANT IS A PERSON:
I,_______________(print applicant name), affirm or swear that the information which I have provided on the application and the attached is true and accurate and contains no misstatement of facts. I understand, if any of the information is found to be untrue, the application will be disapproved.
Date:___________________         __________________________________________
                           Applicant’s Signature
IF APPLICANT IS A PARTNERSHIP OR CORPORATION.
I, _______________________am an officer of__________________affirm or swear that the information which I have provided on THE application and the attached is true and accurate and contains no misstatement of facts, understand if any of the information is found to be untrue, the application will be disapproved.
____________________________________      _____________________________
Signature                            Title
                                 (SEAL, if applicable)
Date: ___________________
(For Individual)
NORTH CAROLINA
GASTON COUNTY
   I, _____________________________, Notary Public for the aforesaid State and County, do hereby certify that ___________________________ personally appeared before me this date and, after being first duly sworn, did the he or she executed the foregoing application and that the matters set forth therein are true and accurate and contains no misstatement to his or her best knowledge and belief.
Witness my hand and notarial seal, this _______ day of _________________, 20____.
                     _____________________________________
                     Notary Public
My Commission Expires: _______________
(For Partnership or Corporation)
NORTH CAROLINA
GASTON COUNTY
   I, _________________________, Notary Public for the aforesaid State and County, do hereby certify that __________________________ personally appeared before me this date and, after being first duly sworn, did the he or she executed the foregoing application in behalf of ___________________________________, that he or she is a partnership (if applicable), or that he or she is the ________of the corporation (if applicable), and that the matters set forth therein are true and accurate and contains no misstatement to his or her best knowledge and belief.
Witness my hand and notarial seal, this ________ day of __________________, 20____.
                     _____________________________________
                     Notary Public
My Commission Expires: _______________
FOR TOWN USE:
The undersigned have investigated the applicant seeking the license and/or the place sought to be licenses and hereby indicate our respective determinations that the applicant and/or place meets and complies with the ordinances and regulations of the Town of Dallas and the State of North Carolina. If any of the below does not recommend approval, the official will submit in writing reason for disapproval.
TOWN CLERK:
Received: _____   Approved _____   Disapproved: _____
POLICE CHIEF:
Submitted to: _____________________   Received from: ________________________
Approved: ____    Disapproved: ____   Date: _________
FIRE CHIEF:
Submitted to: _____________________   Received from: ________________________
Approved: ____   Disapproved: ____   Date: _________
INSPECTOR:
Submitted to: _____________________   Received from: ________________________
Approved: ____   Disapproved: ____   Date: __________
(Prior Code, § J-III-Form-1)