Fillable CARRIAGE COMPANY LICENSE APPLICATION LICENSE SECTION (City of Columbus)

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CARRIAGE COMPANY LICENSE APPLICATION LICENSE SECTION (City of Columbus)

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  • 18 check-boxes
  • 45 other fields

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File type: PDF

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Revised 3/23/2016 Page - 1 - of 2
OFFICE USE ONLY
LICENSE # _______________________
ISSUE DATE______________________
EXPIRES ________________________
BUSINESS INFORMATION
Business Name: Federal ID:
Check One: Sole Proprietor Corporation Partnership LLC
Business Address:
City: State: Zip Code:
Phone Number: Cell Phone:
Email:
OWNER INFORMATION
Full Name:
Date of Birth: Email:
Current Address:
City: State: Zip Code:
Phone Number: Cell Phone:
Ohio Driver’s License Number: Expiration Date:
Sex: M F
Race: Height: Weight: Hair: Eyes:
Are you legally authorized to work in the United States? YES NO
All applicants will be required to prove Lawful Presence in the United States and provide
Proof of Identity.
Have you had a City of Columbus license and/or permit revoked, suspended or refused within the last three (3) years?
YES NO If yes, please explain:
Have you ever been convicted of a felony? YES NO
List all felony convictions in the United States over the past seven (7) years. If none, write “NONE”.
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 began:
DEPARTMENT OF PUBLIC SAFETY
LICENSE SECTION
CARRIAGE COMPANY
LICENSE
APPLICATION
NEW RENEWAL
Revised 3/23/2016 Page - 2 - of 2
List the name, date of birth, driver’s license number or State ID number, home address and title of all persons who
have a direct or indirect interest in the business (including partners, stockholders, lien holders and corporate officer):
1.
Name
Date of Birth
OL or State ID #
Title Home Address Zip Code
2.
Name
Date of Birth
OL or State ID #
Title
Home Address
Zip Code
Attached additional sheet(s) if necessary.
Number of horses to be licensed:
Location of Stable:
Location of staging area:
Owner of Property:
Address:
Phone:
What rates will be charged:
List all criminal arrests and convictions within the past seven (7) years of any person having direct interest in
that which is to be licensed (If none write “NONE”):
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 OR FUTURE REVOCATION OF THIS
LICENSE, AS WELL AS CRIMINAL PROSECUTION UNDER CHAPTER 2321.13(A-3), (A-5) AND COLUMBUS CITY CODE 589.
State of Ohio, County of Franklin
_____________________________________________________, being duly sworn, deposes and says
(Print Applicant Name)
he/she is the individual making the foregoing application; that he/she is knowledgeable with respect to that which is
to be licensed; that the answers to the foregoing questions and other statements contained herein are true of his/her
own knowledge and belief.
_______________________________________________________
(Applicant Signature)
Swore to before me and subscribed in my presence this ____________ day of _______________, 20______
__________________________________________________________
Notary or Agent of Director of Public Safety
MUST BE SIGNED, DATED and NOTARIZED
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CARRIAGE COMPANY LICENSE APPLICATION LICENSE SECTION (City of Columbus)

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Completed 21 January 2021

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