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)