Date:

Corporate Name, if applicable:     

Address of Incorporation:

Telephone Number of Individual or Corporation:

Date of Birth:    Sex:

Height:Weight:Eye Color:  Hair Color:

Items to Be Sold or Services to be Rendered:

If Vehicle is used, Year and Make of:

Color: Identification Number:

Plate Number:

 Length of Time for Which Application is being Made: Week Year (License Expired January 1 or Succeeding Year).

Sales Tax Number:

Certificate Number from Sealer of Weights and Measures, if Using Measuring or Weighing Device:

If Pre-payment is required for Services, Bond in the amount of $500.00 Submitted, approved by Corporation Counsel?          Yes  No (Must be retained by City for at least ninety (90) days after expiration of License).

If Yes, What Crime(s), Date(s), Place(s) of Conviction:

Character References                                

1)

2)

3)

                                                                                                            ____________________________________

                                                                                                                    Signature of Applicant

                                                                                      Application Approved by:  _______________________Mayor

                                                                             License Issued By:       ____________________________________

                                                                                                                                             City Clerk

                                                                               Lettering Approved By: _________________________________

                                                                                                                                                        Police Agent:______