The undersigned hereby applies for a license to conduct the business of _____________ in the City of Vienna and states that the following facts are true:
(1) Name under which business is to be conducted:
(2) Name of applicant. ______________________________ (If a corporation, give names and addresses of president and secretary; if a partnership, give names and addresses of all parties): _______________________
(3) Present residence _____________________
(4) Address of business to be conducted __________________________
(5) Nature of business _________________________________
(6) Residence of applicant during past five years (if individual) _______________________
(7) The applicant has never had a license to conduct the business herein described denied or revoked, excepting as noted: ________________________________
(8) The applicant (including all partners or the officers; if a corporation) has never been convicted of a felony __________________________________________
The undersigned makes these statements above to induce the City of Vienna to issue the license herein applied for, and agrees to comply with all laws and codes of the city, applicable to the subject matter thereof.
Signed this ___________ day of ________, 20____.
(If applicant is a corporation show office held by person signing)
License period from _____________ to __________________.
(1975 Code, § 8.16)