Fillable PAWN BROKERS / PRECIOUS METALS AND GEMS (Charter Township of Waterford)

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PAWN BROKERS / PRECIOUS METALS AND GEMS (Charter Township of Waterford)

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U.S.A. forms for Charter Township of Waterford

BROWSE CHARTER TOWNSHIP OF WATERFORD (MI) FORMS

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CHARTER TOWNSHIP OF WATERFORD
CLERK’S OFFICE
5200 Civic Center Dr. Waterford, MI 48329
Phone 248-674-6266 Fax 248-674-5455
Web Page www.waterfordmi.gov
PAWN BROKERS / PRECIOUS METALS AND GEMS
APPLICATION
Page 1 of 3
Renewal New Application Pawn Brokers Application Fee: $300.00
Precious Metals and Gem License: $50.00
Total due with submittal: $________
1. Contact Information
NAME
ADDRESS
CITY
STATE
ZIP
EMAIL ADDRESS PHONE
2. Name and Location of Business
BUSINESS NAME BUSINESS PHONE NUMBER
ANY ASSUMED NAMES
ADDRESS
CITY STATE ZIP
PARCEL ID NUMBER CURRENT ZONING
3. Property Owner
NAME DATE OF BIRTH
STREET ADDRESS
CITY
STATE
ZIP CODE
CELL PHONE / BUSINESS PHONE
EMAIL ADDRESS
Date Received: Non-Refundable Application Fee Paid __________________
Date Sent to Depts: Response from Police: Response from Fire
Response from Zoning Response from Treasurer Response from DPW
Response from Building License Number (if issued)
MCL 446.201 (2) Licensure under either or both of the following acts does not exempt a person from obtaining a license under this act:
(a) The precious metal and gem dealer act, 1981 PA 95, MCL 445.481 to 445.492.
Page 2 of 3
4. This license will be held by
Individual (Attach copy of any Assumed Name Certificate)
Partnership (Attach a copy of Partnership Certificate)
Corporation (Attach a copy of Articles of Incorporation)
5. Complete the following information on each owner/manager/employee (attach additional sheets if needed):
NAME
TITLE PHONE NUMBER
ANY OTHER NAME OR ALIAS THIS INDIVIDUAL HAS BEEN KNOW BY DRIVER’S LICENSE NUMBER
ADDRESS
CITY
STATE
ZIP CODE
LIST ALL FELONY AND MISDEMEANOR CONVICTIONS ARRESTING AGENCY DATE
LIST ALL FELONY AND MISDEMEANOR CONVICTIONS
ARRESTING AGENCY
DATE
LIST OCCUPATION OR EMPLOYMENT DURING THE LAST 3 YEARS
DATE OF BIRTH SOCIAL SECURITY NUMBER
NAME
PHONE NUMBERS
ANY OTHER NAME OR ALIAS THIS INDIVIDUAL HAS BEEN KNOW BY DRIVER’S LICENSE NUMBER
ADDRESS
CITY
STATE
ZIP CODE
LIST ALL FELONY AND MISDEMEANOR CONVICTIONS ARRESTING AGENCY DATE
LIST ALL FELONY AND MISDEMEANOR CONVICTIONS
ARRESTING AGENCY
DATE
LIST OCCUPATION OR EMPLOYMENT DURING THE LAST 3 YEARS
DATE OF BIRTH SOCIAL SECURITY NUMBER
Page 3 of 3
6. ATTACH an ichat criminal background check for each applicant.
I, the undersigned applicant, have read and understand each and every provision and requirement of Waterford
Township Code Chapter 10 Article IX regarding the regulation of pawnbroking activities in the Township; and I
will provide such other information that the Township requests and deems necessary, in its reasonable discretion, to
discover the truth of the matters required to be set forth in this application or required by Township Ordinances:
YES. NO.
I, THE UNDERSIGNED APPLICANT, HEREBY SWEAR THAT ALL OF THE STATEMENTS, ANSWERS AND
INFORMATION I HAVE PROVIDED IN OR AS PART OF THIS APPLICATION ARE TRUE, ACCURATE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE. AND I UNDERSTAND AND ACKNOWLEDGE THAT ANY
FALSEHOODS OR MISREPRESENTATIONS CONTAINED IN SUCH STATEMENTS, ANSWERS OR
INFORMATION CAN, AMONG OTHER THINGS, BE THE CAUSE OF A DENIAL OF THE REQUESTED
LICENSE AND CAUSE FOR THE REVOATION OF ANY LICENSE ISSUED TO THE APPLICANT UNDER
CHAPTER 10 OF THE WATERFORD TOWNSHIP CODE.
DATE: SIGNED:
PRINT NAME:
Note: If signer is signing on behalf of a corporation, partnership or
LLC, identify the signer’s position and authority to sign in such
capacity.
Acknowledged before me on
By
Acting in County, Michigan
Notary Public
______________________________ County, Michigan
My Commission Expires:
Rev 10/2017
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PAWN BROKERS PRECIOUS METALS AND GEMS (Charter Township of Waterford)

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Completed 17 July 2020

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