BUSINESS LICENSE APPLICATION
APPLICATION NO. ANNUAL LICENSE FEE DUE MAY 1: $__________
(PLEASE TYPE OR PRINT)
1. Applicant’s Name:______________________Phone ( )_____________
2. Applicant’s Address _________________________________
City _______________________State ___ Zip ______________
3. Length of resident at above address ______years _______ months
4. Applicant’s date of birth _____/_____/_____ Social Security No. ______________________
5. Marital Status _______ Name of Spouse ________________________
6. Citizenship of Applicant ________________________________________
7. Business Name ________________________________________
8. Business Address __________________________________
City ____________ State ________________ Zip ______________
9. Length of employment __________years _________ months
10. All residences and addresses for the last three (3) years if different than above:
_____________________________________________________________
_____________________________________________________________
11. Name and address of employers during the last three (3) years if different than above:
_____________________________________________________________
_____________________________________________________________
12. List the last three (3) municipalities where applicant has carried on business immediately preceding the date of application
_____________________________________________________________
13. A description of the subject matter that will be used in the applicant’s business:
_____________________________________________________________
14. Has the applicant ever had a license in this municipality?
[ ] Yes [ ] No
[ ] Yes [ ] No
If so, when? ________________________________________________________________
15. Has a license issued to this applicant ever been revoked?
[ ] Yes [ ] No
If “yes”, explain ___________________________________________________________
16. Has the applicant ever been convicted of a violation of any of the provisions of this code, etc.?
[ ] Yes [ ] No If “yes”, explain: ______________________________________
____________________________________________________________
17. Has the applicant ever been convicted of the commission of a felony?
[ ] Yes [ ] No
If “yes”, explain ___________________________________________________________
18. LICENSE DATA: Term of License ______________________________
Fee for License _____________________________
Sales Tax Number ____________________________
License Classification _________________________
19. LIST ALL OWNERS IF LICENSE IS FOR LOCAL BUSINESS (PERMANENT):
____________________________________
____________________________________ ____________________________________
(2009 Code, Ch. 7)