Fillable LONGVIEW CITY ORDINANCE NO. 3684 APPLICATION FOR METAL (City of Longview)

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LONGVIEW CITY ORDINANCE NO. 3684 APPLICATION FOR METAL (City of Longview)

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REC-11 (08/2011)
LONGVIEW POLICE DEPARTMENT
P.O. BOX 1952
LONGVIEW, TEXAS 75606-1952
(903) 237-1199
(903) 757-5560 FAX
APPLICATION FOR METAL RECYCLING LICENSE
LONGVIEW CITY ORDINANCE NO. 3684
THIS APPLICATION FOR (PLEASE CHECK ONE): ___NEW LICENSE ___LICENSE RENEWAL
ATTACH ADDITIONAL PAGES IF MORE ROOM IS NEEDED FOR ANSWERS
APPLICANT INFORMATION:
FULL NAME OF APPLICANT:
LAST FIRST MIDDLE
OTHERS NAMES USED (MAIDEN NAME, OTHER MARRIED NAMES):
RESIDENT ADDRESS:
RESIDENT PHONE: DRIVER’S LICENSE NUMBER:
DATE OF BIRTH: PLACE OF BIRTH:
ARE YOU A UNITED STATES CITIZEN? ____ YES ____ NO
ARE YOU AN ALIEN LEGALLY RESIDING IN THE UNITED STATES? ____ YES ____ NO
LIST ALL ADDRESSES WHERE YOU HAVE RESIDED IN THE LAST FIVE (5) YEARS IMMEDIATELY PRECEDING THIS
APPLICATION:
HAVE YOU EVER BEEN ARRESTED, CHARGED OR CONVICTED FOR ANY CRIMINAL OFFENCE IN THIS STATE OR ANY
OTHER STATE OR COUNTRY. ____ YES ____ NO
IF YES, LIST THE OFFENSE/OFFENSES, WHETHER YOU WERE ARRESTED, CHARGED OR CONVICTED, THE DATE/DATES
OF CONFINEMENT, THE PLACE, COURT AND CASE NUMBER OF THE CASE.
OFFICE USE ONLY
DATE RECEIVED IN RECORDS: ___________ BY: ________
FEE PAID: ______________ DATE_______________
**************************************************
Fee: $50.00
REC-11 (08/2011)
BUSINESS INFORMATION:
NAME OF BUSINESS:
ADDRESS AT WHICH APPLICANT WILL OPERATE BUSINESS AND MAINTAIN RECORDS:
REGULAR DAYS AND HOURS OF OPERATION:
BUSINESS PHONE NUMBER: FEDERAL TAX ID NUMBER:
IF APPLICANT IS A PARTNERSHIP (ANSWER THIS SECTION IF THE BUSINESS IS A PARTNERSHIP):
FULL NAME, RESIDENT ADDRESS, RESIDENT PHONE NUMBER OF EACH PARTNER:
HAVE YOU OR ANY PARTNER TO THIS BUSINESS HAD A LICENSE GOVERNING THE BUSINESS DESCRIBED IN THE
METAL RECYCLING ENTITIES ORDINANCE REVOKED? ____ YES ____ NO
HAS ANY PARTNER TO THIS BUSINESS EVER BEEN ARRESTED, CHARGED OR CONVICTED FOR ANY CRIMINAL
OFFENCE IN THIS STATE OR ANY OTHER STATE OR COUNTRY. ____ YES ____ NO
IF YES, LIST THE NAME OF EACH PARTNER, THE OFFENSE/OFFENSES, WHETHER HE/SHE WAS ARRESTED, CHARGED
OR CONVICTED, THE DATE/DATES OF CONFINEMENT, AND THE PLACE, COURT AND CASE NUMBER OF THE CASE.
REC-11 (08/2011)
IF APPLICANT IS A CORPORATION OR LIMITED LIABILITY COMPANY (ANSWER THIS SECTION IF THE
BUSINESS IS A CORPORATION LIMITED LIABILITY COMPANY):
FULL NAME, RESIDENT ADDRESS, RESIDENT PHONE NUMBER OF EACH OFFICER AND/OR DIRECTOR:
HAVE YOU OR ANY OFFICER AND/OR DIRECTOR FOR THIS BUSINESS HAD A LICENSE GOVERNING THE BUSINESS
DESCRIBED IN THE METAL RECYCLING ENTITIES ORDINANCE REVOKED? ____ YES ____ NO
HAS ANY OFFICER AND/OR DIRECTOR FOR THIS BUSINESS EVER BEEN ARRESTED, CHARGED OR CONVICTED FOR
ANY CRIMINAL OFFENCE IN THIS STATE OR ANY OTHER STATE OR COUNTRY. ____ YES ____ NO
IF YES, LIST THE NAME OF EACH OFFICER AND/OR DIRECTOR, OFFENSE/OFFENSES, WHETHER HE/SHE WAS
ARRESTED, CHARGED OR CONVICTED, THE DATE/DATES OF CONFINEMENT, AND THE PLACE, COURT AND CASE
NUMBER OF THE CASE.
REC-11 (08/2011)
ATTACH PROOF OF OWNERSHIP OR A WRITTEN STATEMENT INCLUDING THE NAME, ADDRESS AND TELEPHONE
NUMBER OF THE PROPERTY OWNER, OR AUTHORIZED AGENT GRANTING PERMISSION FOR OPERATION OF THE
BUSINESS AT THE PROPOSED LOCATION WHERE THE BUSINESS WILL BE OPERATED. IF THE PROPERTY OWNER IS A
PARTNERSHIP OR CORPORATION THE STATEMENT SHALL INCLUDE THE NAME, ADDRESS, AND THE TELEPHONE
NUMBER OF ONE OF THE PARTNERS OR ONE OF THE PRINCIPALS.
I, THE UNDERSIGNED, UNDERSTAND THAT A BACKGROUND INVESTIGATION WILL BE
CONDUCTED TO ESTABLISH MY ELIGIBILITY FOR THIS LICENSE.
I, THE UNDERSIGNED, UPON OATH STATE THAT ALL ANSWERS ON THIS APPLICATION
ARE TRUE AND CORRECT. I AM AWARE THAT ANY FALSE OR MATERIALLY INCOMPLETE
ANSWERS ARE GROUNDS FOR DENIAL OF THIS LICENSE OR REVOCATION OF LICENSE.
APPLICANT SIGNATURE
DATE
STATE OF TEXAS §
COUNTY OF GREGG §
BEFORE ME, A NOTARY PUBLIC, ON THIS DAY PERSONALLY APPEARED __________________________________,
KNOWN TO ME TO BE THE PERSON WHOSE NAME IS SUBSCRIBED TO THE FOREGOING DOCUMENT AND, BEING BY
ME FIRST DULY SWORN, DECLARED THAT THE STATEMENTS THEREIN CONTAINED ARE TRUE AND CORRECT.
SIGNED THIS THE ________ DAY OF ________________________________, 20______.
NOTARY PUBLIC IN AND FOR THE STATE OF TEXAS
MY COMMISSION EXPIRES:
ONCE APPLICATION IS COMPLETE, PLEASE INCLUDE A COLOR COPY OF THE APPLICANTS
DRIVERS LICENSE ALONG WITH ANY OTHER REQUIRED DOCUMENTS AND MAIL TO THE
ADDRESS LISTED BELOW ALONG WITH THE APPLICATION FEE. ONCE PROCESSED YOUR
PERMIT WILL BE
MAILED TO THE ADDRESS LISTED ON THIS APPLICATION.
LONGVIEW POLICE DEPARTMENT
ATTN: RECORDS DEPT
P.O. BOX 1952
LONGVIEW, TEXAS 75606
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LONGVIEW CITY ORDINANCE NO. 3684 APPLICATION FOR METAL (City of Longview)

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Completed 3 August 2020

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