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Rev 1/14/2019
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
I, _____________________________________, 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.
