Fillable CARNIVAL/CIRCUS INFORMATION SHEET Carnival/Circus License Application Proof of (City of Columbus)

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CARNIVAL/CIRCUS INFORMATION SHEET Carnival/Circus License Application Proof of (City of Columbus)

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DEPARTMENT OF PUBLIC SAFETY
LICENSE SECTION
CARNIVAL/CIRCUS
INFORMATION SHEET
REQUIREMENTS
• Carnival/Circus License Application
• Proof of Identity (i.e. State issued Driver’s License/I.D. Card, Military I.D., Passport)
• Residential Petition
(Only needed if operating within 200 feet of a residential area)
• BCI Background Check/Fingerprints
(If conducted at another authorized WebCheck agency, results must be mailed to the License Section)
PRICING
• Application fee - $20.00
• BCI Background Check fee - $32.00
• Carnival/Circus License fee - $50.00 per day
OFFICE LOCATION & HOURS
4252 Groves Road
Columbus, OH 43232
Monday - Friday
8:00 a.m. to 3:30 p.m.
THIS PAGE INTENTIONALLY LEFT BLANK
Page 1 of 2
Rev 01/02/2019
DEPARTMENT OF PUBLIC SAFETY
LICENSE SECTION
CARNIVAL/CIRCUS
APPLICATION
NEW RENEWAL
APPLICANT INFORMATION
Full Name:
Residential Address:
City: State: Zip:
Phone: Email:
Date of Birth: Driver License #: State:
Race: Sex: Height: Weight: Hair: Eyes:
Have you ever been convicted of a felony? Yes No
If yes, list all felony convictions that occurred in the United State over the past seven (7) years:
Are you on felony probation or parole? Yes No If yes, date began:
Have you ever been required to register as a sexual offender? Yes No If yes, date registered:
Have you had a City of Columbus license and/or permit revoked, suspended, or revoked within the last three (3) years?
Yes No
BUSINESS INFORMATION
Business Type: Single Owner Partnership Incorporated
(If Incorporated, the business name must be exactly as shown on its Articles of Incorporation)
Business Name: Federal ID:
Business Address:
City: State: Zip:
Business Phone: Business Email:
Does this business currently hold a liquor permit? Yes No If yes, permit #:
To the best of your knowledge, has or is any criminal, immoral, or disorderly conduct taken or taking place on the premise of this
business?
Yes No
OFFICE USE ONLY
License # ____________________________
Issue Date ___________________________
Expiration Date _______________________
Page 2 of 2
Rev 01/02/2019
Are there one or buildings used for residential purposes within a distance of two hundred (200) feet, in any direction, from the lot
or parcel of ground on which the carnival will be held?
Yes No
If yes, you must complete and submit the attached Residential Petition with the application.
CARNIVAL/CIRCUS INFORMATION
Name of Person of Contact:
Contact Phone: Contact Email:
Carnival Name:
Event Location:
Date(s) of Carnival/Circus:
Set-up Date: Set-up Time:
Per regulations set in Columbus City Code 501.05(E), the License Section has the power to make rules
regarding the “qualifications of the applicants and the conditions precedent the applicants must meet
prior to the acquisition of licenses.” Following this direction, all applicants must be able to read, speak,
and comprehend the English language in order to obtain a valid license. By initialing on the line below,
you agree that you are able to fulfill this requirement.
_______ Initials
All information contained in this application is subject to disclosure as a matter of public record. Any
false statement made or given in this application shall result in denial, revocation, or future revocation
of the license under Columbus City Code Chapters 501 and 540, and may be referred for criminal
prosecution under Ohio Revised Code Chapter 2921.13 (A-3).
State of Ohio, County of Franklin
_____________________________________, being duly sworn, affirm and swear that I am the
(Print Applicant’s Name)
individual making the foregoing application; that he or she is knowledgeable with respect to that
which is to be licensed and to the information contained in the application; that the answers,
statements, and allegations made in this application are true and accurate to the best of my
knowledge and belief; and that I am an owner/operator/applicant of that which is to be licensed by
this application.
___________________________________
(Applicant’s Signature)
Sworn to before me and subscribed in my presence this _____ day of _______________, 20_____.
______________________________________
Notary or Agent of Director of Public Safety
The application must be signed, dated, and notarized.
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CARNIVALCIRCUS INFORMATION SHEET CarnivalCircus License Application Proof of (City of Columbus)

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Completed 21 January 2021

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