Fillable APPLICATION FOR CURRITUCK COUNTY SHERIFFS OFFICE ADULT LIVE

Fill Online, Printable, Fillable, Blank APPLICATION FOR CURRITUCK COUNTY SHERIFFS OFFICE ADULT LIVE Form

Use Fill to complete blank online OTHERS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

APPLICATION FOR CURRITUCK COUNTY SHERIFFS OFFICE ADULT LIVE

On average this form takes 9 minutes to complete

The APPLICATION FOR CURRITUCK COUNTY SHERIFFS OFFICE ADULT LIVE form is 2 pages long and contains:

  • 0 signatures
  • 4 check-boxes
  • 34 other fields

Country of origin: OTHERS
File type: PDF

BROWSE OTHERS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
**Application Must be Submitted in Person**
1
Currituck County Sheriff’s Office Adult Live Entertainment Performer Application – Revised March 29, 2021
FOR SHERIFF’S OFFICE USE ONLY
Approved: Yes: ______ No: ______
If No, state reason:
___________________________________
Comments:
___________________________________
___________________________________
___________________________________
Initials: __________
Date: ____________________
CURRITUCK COUNTY SHERIFF’S OFFICE
125 College Way
Barco, NC 27917
(252) 453-8204
APPLICATION FOR
ADULT LIVE ENTERTAINMENT
PERFORMER LICENSE
Date: ______________________________
New Application: Non-refundable application and processing fee of $50.00
Renewal Application: Non-refundable application and processing fee of $25.00
Applicant’s Full Name: _______________________________________________________________________
Address of Applicant:
Street: ________________________________________
City: ______________________________ State: __________ Zip Code: ____________________
Phone Number: ______________________________________
Full Name of the Business where Applicant will be performing:
__________________________________________________________________________________________
Physical Address of the Business where the Applicant will be performing:
Street: ________________________________________
City: ______________________________ State: __________ Zip Code: ____________________
Business Phone Number: ______________________________________
Driver License or other Governmental based picture identification:
Number: _____________________
Last 4 of Social Security Number: __________
Date of Birth: _____ / _____ / _____
**Application Must be Submitted in Person**
2
Currituck County Sheriff’s Office Adult Live Entertainment Performer Application – Revised March 29, 2021
APPLICATION FOR ADULT LIVE ENTERTAINMENT PERFORMER LICENSE
List all Cities and State of Residence for the Last 5 Years:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Have you ever been charged with or have any pending sexually oriented crime in the last 5 years?
Yes No
If Yes to the above, please list Date, Offense, City, and State it occurred in:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
If any of the above statements are false, I may be denied a license to operate by the Sheriff.
Applicants Signature: _______________________________________ Date: ________________________
Sworn to and subscribed before me on this ______ day of ________________, 202__.
________________________________________ ______________________________
Notary My Commission Ends
The following must be submitted at time of application:
Copy of Driver License or other Governmental issued picture identification
A good quality photo that meets the guidelines below or submit to having a photo taken at time of application.
Photo must be in .jpg format, it must be taken on a flat solid color background in good lighting.
The image should look similar to a Driver License or Passport photo showing at least the head and
shoulders like this example.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

APPLICATION FOR CURRITUCK COUNTY SHERIFFS OFFICE ADULT LIVE

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 12 November 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document