Fillable Peddler Transient Merchant Application (City of Duluth)

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Peddler Transient Merchant Application (City of Duluth)

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CITY OF DULUTH
CITY CLERK’S OFFICE
330 City Hall ! 411 West First Street
Duluth, Minnesota 55802-1189
Phone (218) 730-5500
Fax (218) 730-5923
LICENSE APPLICATION
G
UIDELINE AND CHECKLIST
Type in your information by tabbing through the boxes below. Print, sign and submit all pages to the address above.
LICENSE TYPE: PEDDLER, SOLICITOR, TRANSIENT MERCHANT
Peddler: A person who offers merchandise or services for sale door-to-door, including
house-to house, business-to- business, street-to-street, or any other type of place-to-place
movement. Delivery and payment occur immediately.
Solicitor: A person who obtains orders for merchandise or services for future delivery.
Registration required. No fee.
Transient Merchant: A person who temporarily sets up
bus
iness out of a
v
ehicle, trailer,
boxcar, tent, other portable shelter, or empty store front for the purpose of selling goods.
Individuals may not remain in one location for more than 14 consecutive days. Delivery and
payment occur immediately.
Non-Commercial Advocate: A person who disseminates religious, political, social, or
other ideological beliefs. No registration or license is required.
Staff
Initials
APPLICATION CHECKLIST
1. LICENSE APPLICATION.
2. PHOTO ID: Attach a copy of a driver’s license or government issued photo
identification card.
3. CRIMINAL BACKGROUND REPORT: Available from www.chs.state.mn.us/ New
Criminal History Search or the Stat
e of Minnesota, Bureau of Criminal
Apprehension, 1430 Maryland Ave. E., St. Paul, MN, 651-793-
2400. If you
have lived in another state within the past ten years, you must attach a report
from the others state(s) you lived. These reports must be dated wit
hin 30 days
of receipt of this application.
4. FEE: $52.00 plus INITIAL INVESTIGATION FEE (one time): $31.00
NOTICE TO APPLICANT:
a. Incomplete applications will not be processed and will be returned.
b. Licenses are not transferable.
c. Make a copy of this packet for your personal records before submitting.
FOR OFFICE USE ONLY
DATE _______________
LICENSE # ___________
CITY OF DULUTH
CITY CLERK’S OFFICE
330 City Hall ! 411 West First Street
Duluth, Minnesota 55802-1189
Phone (218) 730-5500
Fax (218) 730-5923
LICENSE
APPLICATION/REGISTRATION
FOR PEDDLERS, SOLICITORS AND TRANSIENT
MERCHANTS
1. BACKGROUND INFORMATION
Applicant’s Full Legal Name
Peddler
Solicitor
Transient Merchant
All other names you have used or conducted business under (First, Middle, and/or Last)
Residence Address
City
Zip Code
Local Address (If residence address is out of
state)
City
Zip Code
Social Security or Individual Tax ID
E-mail Address
Cell Phone Number
Name of Business/Company
Telephone Number
Fax Number
Street Address of Business
City
Zip Code
Name of Manager
E-mail Address
Cell Phone Number
Describe in detail the type and brand name of the merchandise or services for sale.
List the last three locations where you have worked as a peddler, solicitor, or transient merchant.
1. 2. 3.
Are you an owner operator manager agent and/or employee of any business? If yes, list
the business name(s).
List any licenses currently or previously held in Duluth.
Have you ever had a business license denied or revoked by Duluth or another government entity? Yes No
If yes, indicate the date of denial/revo
cation, governmental agency, and reason for denial/revocation.
2. IDENTIFICATION REQUIREMENTS
Date of Birth (dd/mm/yyyy)
Age
Height
___ ft ___ in
Weight
____ lbs
Hair Color
Eye Color
Race/Complexion
3. VEHICLE INFORMATION
Year
Make
Model
Color
L
icense Plate
Last six digits of VIN
4. DATA PRIVACY ADVISORY – THIS SECTION IS NOT REQUIRED FOR SOLICITOR’S REGISTRATION
Have you been convicted of a felony gross misdemeanor, misdemeanor or ordinance violation for violating any
federal, state or local ordinance other than a minor traffic offense within the last ten years?
Yes No N/A Solicitors
The Minnesota Data Practices Act requires that you be advised of the following information:
As an applicant for a Peddler Li
cense, you are asked to provide private and/or confidential information about
yourself that will be used to check driving history, criminal history, arrest records, warrant information, and other
relevant records. You may refuse to provide this information. However, should you refuse,
our investigation
cannot be completed and will result in your application not being processed.
With the exception of your Social
Security Number, the information you provide is public and will be used by the Duluth Police Department, the
Duluth City Council and/or the general public.
This AUTHORIZATION FOR RELEASE OF INFORMATION will expire
two years from the date you sign it.
I have read and understand the above Data Practices Advisory.
Signature _________ Date _____________________
5. VERIFICATION
The data you furnish on this application will be used by the City of Duluth to assess your qualifications for
licensu
re. Disclosure of this information is voluntary. You are not legally required to provide this data; however, if
you fail to do so, the City of Duluth
may be unable to process this application. Disclosure of your Minnesota Tax
ID Number, Social Security N
umber, or Individual Tax ID Number is required by Minnesota Statutes 270C.72, and
your Social Security number may be requested by and released to the Minnesota Commissioner of Revenue. After
submission, all information contained in this application except
your Social Security Number will be public
information pursuant to Minnesota Statutes, Chapter 13.
A SIGNATURE IS REQUIRED IN ORDER TO PROCESS THIS APPLICATION.
I, (print name) ___________________________________________________, certify or declare under
penalty of
perjury under the laws of the State of Minnesota that the foregoing is true and correct. All information given is
subject to verification by the State of Minnesota. I understand that false information may result in the denial,
suspension or revocation of my business license.
SIGNATURE OF APPLICANT ____________________________________________ DATE ___________________
LIC 04 (3/13)
Certificate of Compliance
Minnesota Workers’ Compensation Law
THIS FORM MUST BE COMPLETED BY THE BUSINESS LICENSE APPLICANT
PRINT IN INK or TYPE.
Minnesota Statutes, Section 176.182 requires every state and local licensing agency to withhold the issuance or renewal of a
license or permit to operate a business in Minnesota until the applicant presents acceptable evidence of compliance with the
workers' compensation insurance coverage requirement of Minnesota Statutes, Chapter 176. If the required information is not
provided or is falsely stated, it shall result in a $2,000 penalty assessed against the applicant by the commissioner of the
Department of Labor and Industry.
A valid workers’ compensation policy must be kept in effect at all times by employers as required by law.
LICENSE or CERTIFICATE NO (if applicable)
BUSINESS TELEPHONE NO.
FAX TELEPHONE NO.
BUSINESS NAME
(Use the person(s) name if business structure is sole proprietor or partnership (i.e., John Doe, or John Doe and Jane Doe), otherwise it is
the legal name of the business entity.)
DBA (“doing business as” or also known as an assumed name) (if applicable)
BUSINESS ADDRESS (must be physical street address, no PO boxes)
CITY STATE ZIP CODE
COUNTY
E-MAIL ADDRESS
YOUR LICENSE OR CERTIFICATE WILL NOT BE ISSUED WITHOUT THE
FOLLOWING INFORMATION. You must complete number 1 or 2 below.
NUMBER 1 – Workers’ compensation insurance policy information
INSURANCE COMPANY NAME (not the insurance agent)
NAIC Number
POLICY NO.
EFFECTIVE DATE
EXPIRATION DATE
NUMBER 2 – Reason for exemption from workers’ compensation insurance
If you have questions regarding the need to obtain workers’ compensation coverage, including exemptions, contact
651.284.5032 or 1-800-342-5354.
I have no employees. (See Minn. Stat. § 176.011, subd. 9 for the definition of an employee.)
I am self-insured for workers’ compensation (attach a copy of the authorization to self-insure from the Minnesota
Department of Commerce).
I have employees but they are not covered by the workers’ compensation law. (See Minn. Stat. § 176.041 for a list of
excluded employees.) Explain why your employees are not covered:
______________________________________________________________________________________________
Other: _________________________________________________________________________________________
I certify that the information provided on this form is accurate and complete. If I am signing on behalf of a business, I certify that I am
authorized to sign on behalf of the business.
PRINT NAME
APPLICANT SIGNATURE (required)
TITLE
DATE
NOTE: You must notify us if there is any change to your Workers’ Compensation Insurance Information or Employee Status Change by resubmitting this form.
This material can be made available in different forms, such as large print, Braille or on a tape.
Reset
MN STATUTE 270C.72 TAX IDENTIFICATION FORM
Pursuant to Minnesota Statute 270C.72, Tax Clearance Required: The licensing authority is
required to provide the Minnesota Commissioner of Revenue the business tax identification
number and social security number of each applicant. Under the Minnesota Government
Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the
following regarding the use of this information:
1. This information may be used to deny the issuance, renewal or transfer of your license in the event you
owe the Minnesota Department of Revenue delinquent taxes, penalties or interest.
2. Upon receiving this information, the licensing authority will supply it only to the Minnesota Department of
Revenue. However, under the Federal Exchange of Information Agreement, the Department of Revenue
may supply this information to the Internal Revenue Service.
3. Failure to supply this information may jeopardize or delay the processing of your licensing issuance or
renewal application.
Please supply the following information and return along with your application to the agency issuing
the license.
License applied for or renewed: ___________________________________________________
Licensing authority: City of Duluth, St. Louis County, Minnesota
License renewal date: _______________________
Personal Information (if applicable)
Applicant’s Name: ______________________________________________________
Applicant’s Address: ______________________________________________________
Social Security Number: ______________________________________________________
Business Information (if applicable)
Business Name: ___________________________________________________________
Business Address: ___________________________________________________________
Minnesota Tax Identification Number: ______________________________________________
Federal Tax Identification Number: ______________________________________________
If a MN Tax I.D. is not required, please explain:
Signature ____________________________________ Date ________________
PEDDLERS AND SIMILAR ACTIVITY
FREQUENTLY ASKED QUESTIONS
1. I am interested in selling items around town, possibly at different locations and events, what is
needed?
There is a "Peddlers" license for a person/business that "goes from place to place, with a product for sale."
Those taking orders for a later delivery, nonprofits and those who DO NOT “go from place to place” are NOT
REQUIRED to secure this license, but some still choose to secure the peddlers license. In addition, depending
on the particular type of product, there might be an additional license required, for example, for fireworks contact
the Duluth Fire Department, for food contact the Minnesota Department of Health. Also, depending on the
product, it might be subject to City of Duluth Sales Tax.
2. What are the restrictions as to where a person can sell, regardless of needing a license or not?
You CANNOT be on private property without their permission. In addition, you cannot be on the Corps of
Engineers’ property adjacent to the Aerial Lift Bridge. If on public streets or sidewalks you CANNOT interfere
with either vehicular or pedestrian traffic, that is, you CANNOT be “set-up” in one location and “plug” the parking
meter, you must continue to move from place to place. (Note: The whole bricked area in Canal Park, bordered
by Canal Park Drive, Buchanan Street and Lake Avenue is a public area, and you CANNOT be “set-up,” you
must keep moving.) For public property other than public streets or sidewalks, one needs permission from the
City Property Manager. Peddler permits cannot be used in public parks.
3. When there is something like Sidewalk Days or Grandma’s Marathon when the public streets are
closed are there any further restrictions?
If there is an approved special events permit for an area (i.e. Sidewalk Days, Grandma's Marathon, etc.) a
person/business interested in selling items must get permission from the holder of the approved special events
permit to sell in the special events permit area.
4. What are the regulations relative to Bayfront Festival Park?
In the case of large events, such as Fourth Fest or the Blues Fest, the approved promoter has the authority for
approving what vendors are at the specific events.
Buskering, which is providing “entertainment,” is allowed only in designated areas of the Lakewalk and in Lake
Place Park with an approved permit from the Parks and Recreation Division.
5. Contact Information:
City Clerk 730-5500 City Parks & Recreation 730-4300
City Property Manager 730-4434 City Sales Tax 730-5350
City Fire Department 730-4394 City Licensing Officer 730-5421
Minnesota Department of Health 723-4642 City Parking Manager 730-5178
Updated 11/29/2012
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Peddler Transient Merchant Application (City of Duluth)

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Completed 15 July 2020

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