OFFICE OF THE TOWN CLERK
KATE MURRAY
Town Clerk
One Washington Street Hempstead, NY 11550
Tel: (516) 812-3025 email: licensing@tohmail.org
PAWN BROKERS LICENSE
Rev. 1/20
License #
Filing Fee
Date Revieved
Issued
Fee Paid
Name of applicant:
Phone #
( ) -
Phone #
( ) -
Address:
. .
Exact location of business:
CORPORATION, CO-PARTNERSHIP OR INDIVIDUAL USING A TRADE NAME
Town:
Office Use Only
Corporation, or trade name:
Main office:
Incorporated ?
Partner or
President
Does any person other than listed above have any interest in this business ?
Partner or
Vice President
Partner or
Secretary
Partner or
Treasurer
Date: / /
YES
Phone # ( ) -
State:
NO
YES NO
Name Address
RENEWALFIRST TIME
DONALD X. CLAVIN JR.
Supervisor
Rev. 1/20
CORPORATIONS
INDIVIDUAL APPLICATION
A corporation must furnish a photostatic copy of the filing receipt for the Certificate of Incorporation
fr
om the New York State Secretary of State. A corporation from outside New York State must furnish a
photostatic copy of its application for authority to do business in New York State from the New York State
Secretary of State. Some applications require proof of the election of the corporate officers, and in such
cases, there must be a filed copy of the minutes of the corporation meeting, electing directors and
officers.
All Officers must be fingerprinted and also any stockholder of ten (10) percent or more of the stock.
Individuals operating under a trade name must present a certified copy of the trade name certificate in
the County Clerk’s Office.
PARTNERSHIP
A partnership conducting business whether or not under a trade name, must submit a certified copy of
partnership certificate filed in The County Clerk’s Office.
SURETY BOND
Surety Bond in the Amount of Ten thousand Dollars ($10,000). Made payable to the Town of Hempstead.
If the applicant is a corporation, state its principal place of business and the name and address of a
person residing within the Town of Hempstead on whom papers may be served:
The applicant hereby states that no person has provided any funds for the organization or operation of
this business except as stated in this application and if any such funds are hereafter obtained the Town of
Hempstead is to be notified immediately: and in the event of a change of officers, directors or stockhold-
ers, the Town of Hempstead be informed forthwith of license may be revoked.
Being duly sworn deposes and says: that he is the applicant above named, that he has read the foregoing
application for a license, and knows the contents thereof and that the same is true and his own knowl-
edge, except as to the matters therein stated to be alleged upon information and belief and that as to
those matters he believes to be true.
THIS AFFIDAVIT MUST BE COMPLETED
STATE OF NEW YORK
COUNTY OF NASSAU
)
)
ss:
Sworn to before me this
Day of 20
NOTARY PUBLIC
Signature of Applicant
. .
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome