Town of Fishkill Clerk's Office
Application for License to Engage in Business as a
Dealer in Second-hand Junk and Auto Parts Activities
Name of Applicant: ___________________________________________
Address:
_________________________________
_________________________________
Date of Birth: _____________________ Place of Birth: ___________________________
Citizen of the United States: _______________________
Were you ever convicted of a felony or misdemeanor. If answer is yes, specify:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Description of exact type of business to be conducted:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Nature of Materials: _______________________________________________________
Name and address of owner of property: ______________________________________
________________________________________________________________________
Nature of right of occupancy of land: ________________________________________
________________________________________________________________________
_______________________________________ being duly sworn deposes and swears that
he presently is engaged as a dealer in the second-hand junk and auto parts activities in the
Town of Fishkill, Dutchess County, New York.
Signature
of Applicant:________________________________
Subscribed and Sworn to before me
this _______ day of ________.
_____________________________
Notary Public
Town of Fishkill - 807 Route 52 - Fishkill, NY - 845.831.7800
Town of Fishkill - Application for License to engage in Business as a Dealer in Junk and Auto Parts Activites
