Business License Application - Secondhand Pawn License
265 Strand Street, St. Helens, OR 97051 | 503-397-6272 office | www.sthelensoregon.gov
I hereby certify under penalty of perjury and false swearing that the information I have provided is true and correct.
__________________________________________________
_____________________________
Applicant Signature
Date of Signature
FOR OFFICE USE ONLY
Received By: _____________________________________________________
Police Department Approval: ________________________________________
City Administrator Approval: ________________________________________
Amount Paid: ______________ Receipt Number: ______________
Date: _______________
Date: _______________
Date: _______________
Date: _______________
Business Address: ________________________________
Type of Busin
ess: Pawnbroker
Secondhand Dealer
Name of Business: ______________________________
Business Phone: ____________________
City /
BUSINESS INFORMATION:
If you are a pawnbroker,
State License No. _________________________________
City Business License No. _________________________
If your business is anything but a Sole Proprietorship, list the following information
for ALL partners. Attach an additional page if necessary...
Name: ______________________________ Ti
tle: _____________________
Address: __________________________________________________________
DOB: _______________ Driver's License State/No: _____________________
Name: ______________________________ Title: _____________________
Address: __________________________________________________________
DOB: _______________ Driver's License State/No: ________________________
Name: ______________________________ Title: _____________________
Address: __________________________________________________________
DOB: _______________ Driver's License State/No: ________________________
Is your business:
Sole Propretorship
Partnership
C
_
o
_
r
_
p
_
o
_
r
_
a
_
ti
_
o
_
n
_
Association
Other: ________________
APPLICANT INFORMATION:
Name: __________
___________________ P
hone: ______________________________ Date of Birth: ___________________
Address: ___________________________ City/State/Zip: ________________________
Driver's License State & Number: ____________________ Principal Occupation: _____________________________________________________
PLEASE INCLUDE A COPY OF YOUR BUSINESS LIABILITY INSURANCE WITH YOUR APPLICATION FOR REVIEW.
click to sign
signature
click to edit
![]()
