Applicants for a license under this chapter shall file with the Clerk-Treasurer:
(A) Name and physical description of applicant;
(B) Complete permanent home and local address of the applicant and, in the case of transient merchants, the local address from which proposed sales will be made;
(C) A brief description of the nature of the business and the goods to be sold;
(D) If employed, the name and address of the employer, together with credentials therefrom establishing the exact relationship;
(E) The length of time for which the right to do business is desired;
(F) The source of supply of the goods or property proposed to be sold or orders taken from the sale thereof, where the goods or products are located at the time the application is filed and the proposed method of delivery;
(G) A recent photograph of the applicant which picture shall be approximately 2 inches by 2 inches showing the head and shoulders of the applicant in a clear and distinguishing manner;
(H) If employer is a corporation, the state of its incorporation, whether it is authorized to do business in Indiana and evidence that the corporation has designated a resident agent in the State of Indiana upon whom legal service may be made and that corporation will be responsible for the acts of its employees in the town;
(I) A statement as to whether or not the applicant has been convicted of any crime, misdemeanor or violation of any municipal ordinance, other than traffic violations, the nature of the offense and the punishment or penalty assessed therefor; and
(J) The last cities or villages, not to exceed 3, where applicant carried on business immediately preceding date of application and the addresses from which the business was conducted in those municipalities.
(1982 Code, § 12-4) Penalty, see § 110.99