BUSINESS LICENSE
STATE OF ILLINOIS )
COUNTY OF MADISON ) ss
VILLAGE OF SOUTH ROXANA )
Illinois Sales Tax Number ________________________
TO ALL TO WHOM THESE PRESENTS SHALL BECOME GREETINGS:
WHEREAS _____________________________________________________________, having complied with all the requirements of the laws of the State of Illinois, and the ordinances of the Village of South Roxana, in this behalf made and required license is by authority of the Village of South Roxana given and granted to the said __________________ to _________________ at ____________________ in the Village of South Roxana, County of Madison and State of Illinois from the date hereof until the _______ day of __________________, 20 ____, the said _________________________ to be subject to all laws of the State of Illinois, and all ordinances of the Village of South Roxana, not in conflict therewith, which are now or hereafter may be in force touching the premises.
(L.S)
Given under the hand of the President of the Village of South Roxana, Illinois and the seal thereof, this _____ day of _______________, 20___.
__________________________________
PRESIDENT
SOUTH ROXANA, ILLINOIS
COUNTERSIGNED:
___________________________________
VILLAGE CLERK
SOUTH ROXANA, ILLINOIS
(SEAL)
APPLICANT/FIELD CHECK
INFORMATION CARD
NAME | LOCATION | DATE | TIME | ||||||
RESIDENCE ADDRESS | D.L. # | ||||||||
BUSINESS ADDRESS | VEHICLE | COLOR | YR. | BODY | LICENSE INFO | ||||
OCCUPATION | SOC. SEC. NUMBER | VEHICLE MODIFICATIONS | |||||||
RACE | SEX | HGT | WGT | EYES | ACTION LEADING TO CHECK | ||||
HAIR | |||||||||
COMPLEXION | D.O.B. | ||||||||
UNUSUAL FEATURES | |||||||||
HAT | COAT | ||||||||
CAP | JACKET | ||||||||
BLOUSE | DRESS | ||||||||
SHIRT | SWEATER | ||||||||
SKIRT | |||||||||
TROUSERS | |||||||||
ADDITIONAL COMMENTS | ASSOCIATES | ||||||||
NOTICE TO APPLICANT: The Chief of Police shall have three days to review the application and check the information.