OFFICE OF THE TOWN CLERK
KATE MURRAY
Town Clerk
One Washington Street Hempstead, NY 11550
Tel: (516) 812-3025 email: licensing@tohmail.org
Name:
Address: Email Address:
Address of employer:
Name of employer:
Date of birth:
Height:
Are you a citizen?
Have you ever had an auctioneers license with any other authority ?
If YES please give details:
If naturalized when?
Native born or naturalized:
Weight: Eye color:
Phone # ( ) -
20
Phone # ( ) -
Place of birth:
Age:/ /
Hair color:
Complexion:
Race:
Office Use Only
APP. #
FEE PAID
DATE
LICENSE #
ISSUED
YES NO
YES NO
YES NO
Sworn to before me this
Day of 20
NOTARY PUBLIC
Signature of Applicant
Rev. 1/20
RENEWALFIRST TIME
Were you ever convicted of any crime or offense other than traffic infractions?
In consideration of being granted the license or permit hereby applied for, I agree to comply with all the
rules and regulations that are now in force or that may be promulgated. I further agree to notify the Office
of the Town Clerk immediately of any change of employment or change of residence.
Where
Crime or offense
Penalty imposed Remarks
AUCTIONEER
DONALD X. CLAVIN JR.
Supervisor
Native Born
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome