Fillable PRECIOUS METAL AND GEMS DEALER LICENSE APPLICATION FOR (City of Longview)

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PRECIOUS METAL AND GEMS DEALER LICENSE APPLICATION FOR (City of Longview)

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LONGVIEW POLICE DEPARTMENT
P.O. BOX 1952
LONGVIEW, TEXAS 75606-1952
(903) 237-1199
(903) 757-5560 FAX
REC-11 (08/2011)
APPLICATION FOR
PRECIOUS METAL AND GEMS DEALER LICENSE
LONGVIEW CITY ORDINANCE CHAPTER 76
$20.00 FEE FOR NEW LICENSE OR LICENSE RENEWAL
$10.00 FEE FOR TEMPORARY LICENSE
___ NEW LICENSE ___ LICENSE RENEWAL ___ TEMPORARY LICENSE
IF FOR LICENSE RENEWAL, INDICATE PRESENT LICENSE NUMBER AND DATE OF LICENSE.
LICENSE NUMBER: ____________________ DATE OF LICENSE: ____________________
NAME OF APPLICANT: ________________________________________DOB: ____________
RESIDENT ADDRESS: ___________________________________________________________
ADDRESS CITY STATE ZIP
NAME OF BUSINESS UNDER WHICH APPLICANT WILL OPERATE:
____________________________________________________________________________
ADDRESS AT WHICH APPLICANT WILL OPERATE/PLACE OF BUSINESS AND MAINTAIN RECORDS:
____________________________________________________________________________
ADDRESS CITY STATE ZIP
BUSINESS PHONE: _______________________ ALTERNATE PHONE: ___________________
HOURS OF OPERATION: _________________________________________________________
BACKGROUND INFORMATION
1. HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR?
YES NO
IF YES, LIST CHARGES, LOCATION OF OFFENSE, COURT AND PENALTY IMPOSED:
____________________________________________________________________________
CHARGES LOCATION COURT PENALTY
____________________________________________________________________________
CHARGES LOCATION COURT PENALTY
____________________________________________________________________________
CHARGES LOCATION COURT PENALTY
____________________________________________________________________________
CHARGES LOCATION COURT PENALTY
OFFICE USE ONLY
DATE RECEIVED IN RECORDS: ___________ BY: ________
FEE PAID: ______________ DATE_______________
**************************************************
LICENSE NUMBER __________
____APPROVED ____DENIED DATE _______________
DATE OF EXPIRATION: ________________________
2. HAVE YOU EVER BEEN OR ARE CURRENTLY A PARTY TO ANY CIVIL LITIGATION ARISING OUT
OF SALES OR PURCHASES OF ANY GOODS OR SERVICES
?
YES NO
I
F YES, COURT____________________ DATE_______________
____________________________________________________________________________
COURT LOCATION STATUS/OUTCOME INVOLVED PARTY(IES)
____________________________________________________________________________
COURT LOCATION STATUS/OUTCOME INVOLVED PARTY(IES)
____________________________________________________________________________
COURT LOCATION STATUS/OUTCOME INVOLVED PARTY(IES)
3. H
AVE YOU EVER ENGAGED IN BUSINESS UNDER AN ASSUMED NAME?
YES NO
I
F YES, LIST NAME(S) ___________________________________________________________
____________________________________________________________________________
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 COMPLETE, AND I AM AWARE THAT ANY FALSE OR
MATERIALLY INCOMPLETE ANSWERS ARE GROUNDS FOR DENIAL OF THIS
LICENSE OR REVOCATION OF LICENSE.
_______________
______________________
A
PPLICANT SIGNATURE
_______________
_____________________
D
ATE
ST
ATE
OF TEXAS
COUNTY
OF GREGG
SUB
SCRIBED AND SWORN TO BEFORE ME,
THE UNDERSIGNED NOTARY PUBLIC, ON THIS
____ DAY OF ____________, 20___ .
_______________
______________________
N
OTARY PUBLIC
M
Y 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
REC-11 (08/2011)
EMPLOYEE ADDENDUM
(EACH CURRENT EMPLOYEE MUST HAVE THIS DOCUMENT ON FILE WITH POLICE RECORDS)
NAME OF EMPLOYER: ____________________________________________________ DATE HIRED:________________
NAME OF APPLICANT: ____________________________________________________ DOB: ___________________
RESIDENT ADDRESS: _________________________________________________________________________________
ADDRESS CITY STATE ZIP
BACKGROUND INFORMATION
1. HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR?
YES NO
IF YES, LIST CHARGES, LOCATION OF OFFENSE, COURT AND PENALTY IMPOSED:
__________________________________________________________________________________________________
CHARGES LOCATION COURT PENALTY
__________________________________________________________________________________________________
CHARGES LOCATION COURT PENALTY
__________________________________________________________________________________________________
CHARGES LOCATION COURT PENALTY
__________________________________________________________________________________________________
CHARGES LOCATION COURT PENALTY
2. HAVE YOU EVER BEEN OR ARE CURRENTLY A PARTY TO ANY CIVIL LITIGATION ARISING OUT OF SALES OR PURCHASES OF ANY
GOODS OR SERVICES?
YES NO
IF YES, COURT____________________ DATE_______________
__________________________________________________________________________________________________
COURT LOCATION STATUS/OUTCOME INVOLVED PARTY(IES)
__________________________________________________________________________________________________
COURT LOCATION STATUS/OUTCOME INVOLVED PARTY(IES)
__________________________________________________________________________________________________
COURT LOCATION STATUS/OUTCOME INVOLVED PARTY(IES)
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
COMPLETE, AND 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
SUBSCRIBED AND SWORN TO BEFORE ME, THE UNDERSIGNED NOTARY PUBLIC, ON THIS ____ DAY OF ____________,
20___.
_____________________________________
NOTARY PUBLIC
MY COMMISSION EXPIRES ________________
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PRECIOUS METAL AND GEMS DEALER LICENSE APPLICATION FOR (City of Longview)

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Completed 3 August 2020

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