City of Roswell, P.O. Drawer 1838, Roswell, NM 88202
Attn: Business License Clerk
ITINE
RANT MERCHANT APPLICATION
Present this completed application to Roswell Police Department, 128 W. Second St. for a background check and fingerprinting.
Bring this completed application to the City Licensing Clerk in the Code Enforcement Office, 421 N. Richardson, telephone
(575) 637-6208, for issuance of the permit.
Cost: $100.00 per 120 Hours Seven (7) days advance notice required.
(15 consecutive days)
P
LEASE PRINT
Full Name: _________________________________________________ Telephone No.: ( ) ___________________
Permanent Street Address: ____________________________________________________________________________
City: ______________________ State: _______ Zip: ___________ SSN: ______-_____-______ Sex: F M
(circle one)
Driver=s Lic. No.: ___________________________ State: ______________ Date of Birth: ________________________
Place of Birth: _______________________________________________________ Height: _______ Weight: ______
Hair Color: _______________________ Eye Color: ___________________ Complexion: _______________________
Scars or Identifying Marks (description): ________________________________________________________________
_________________________________________________________________________________________________
Roswell Address (Motel): _____________________________________________ Phone No.: _____________________
Vehicle Description: Year: ___________ Make & Model: ________________________________________________
Color: ______________ License No.: ______________________ State of Issue: ______________________________
Name of Employer: _______________________________________________________ No. Years Employed: _______
Address: ____________________________________ City: ___________________ State: ________ Zip: ____________
Telephone No. ( ) _________________ Residence Last 12 Months: _______________________________________
New Mexico State Tax ID No. (CRS Tax Id #): __________________________________________________________
Type of Goods/Merchandise/Services to be sold: ________________________________________________________
Selling dates: ______________________________________________________________________________________
Selling Location: ___________________________________________________________________________________
***Have you ever been convicted of an offense involving moral turpitude, misdemeanor or felony? Yes_____ No_____
(Moral turpitude of conduct which is contrary to the customary rules or rights and duties between persons or a person and
a society, and would include but not limited to, such conduct as assault, battery, larceny, shoplifting, sexual offenses,
contributing to the delinquency of a minor, theft, fraud, and similar types of conduct). If yes, explain on the reverse of
this form.
_________________________________________________ ________________________________
VENDOR/MERCHANT SIGNATURE Date
Zoning Department Approval (must submit property owner’s permission in writing).
Planning & Zoning Official: ________________________________________ Date: ___________________________
NCIC RECORDS CHECK____________________________ ****PLEASE LIST ARREST HISTORY ON REVERSE
______________________________________________________ __________________________________
POLICE DEPARTMENT SIGNATURE Date
