Fill - Free fillable Permit Application Form -- 12 Pages PDF form

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RICHMONDPOLICEDEPARTMENT

PERMITAPPLICATION

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ChecktheTypeofPermitApplicationRequest

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Initial Renewal

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 AmusementPark   Gold/SilverMerchant   SecondhandDealer

 BilliardParlor   JunkDealer   SkatingRink

 BowlingAlley   Merry‐Go‐Round   Solicitor

 Carnival   Palmistry   TaxiCabOperator’sPermit

 Circus/WildWestShow   Pawnshop   Theater/MotionPicture 

 EmploymentService 

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Pistols&Ammunition&Sales

(LicenseddealerscompleteSections9&10only)

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Miscellaneous

    

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NOTE

Pleaseanswerquestionscompletelyandaccurately.Allanswersmustbeprintedneatlyortyped.

Ifthereisinsufficientspaceforyouranswer,listthesectionnumberandansweronaseparatepieceofpaper.

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Activityforwhichthepermitisbeingrequested:



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NameofPartnershiporFirm(forbusinesspermitrenewal):



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Address

   

Street City State ZipCode

ContactName(forbusinesspermitrenewal):



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ContactAddress:

   

Street City State ZipCode

ContactTelephoneNumber:

  

Home Wor

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Thelengthoftimeittakestoconductaninvestigationdependsontheaccuracyandcompletenessofyourapplication.

Ifyouhaveanyfurtherquestions,pleasecontacttheRichmondPoliceDepartment–Permits&Inspections

Sgt.CorettaMonts–(804)646‐6774

Off.JerryBaskette–(804)646‐4950(PawnShops/Gold&

Silver) Off.AliceSnell–(804)646‐5359(TaxiCabs)

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DateSubmittedtoRichmondPoliceDepartment: 

2

SECTION1–PERSONALHISTORY

LegalNameatBirth

AllOtherNamesyouhaveused(nickname,maidenname,etc.)

SocialSecurityNumber

Race Sex Height

ft in

Weight

lbs

EyeColor HairColor

ListanyScars,MarksorTattoos

DateofBirth PlaceofBirth

City/County State Country

AreyouaU.S.Citizen?

Yes No

IfNaturalized,DateofNaturalization GreenCard#(Ifapplicable)

Haveyoueverbeenarrestedforanyreason? No Yes

Ifyes,Explain(includingDUI):

3

SECTION2–DRIVINGHISTORY

PleaseprovidetheinformationonanyVehicleOperator’sLicense/Permityouhaveheld

TypeofLicense StateofIssuance LicenseNumber DateIssued DateExpired

ListALLTrafficViolationsorCitations(excludingParkingTickets)thatyouhavereceivedinthepast10YEARS

1

Date Charge

LocationofCharge DispositionofCharge

2

Date Charge

LocationofCharge DispositionofCharge

3

Date Charge

LocationofCharge DispositionofCharge

4

Date Charge

LocationofCharge DispositionofCharge

5

Date Charge

LocationofCharge DispositionofCharge

4

SECTION3–EMPLOYMENTHISTORY

StartwithyourPRESENTEMPLOYERandworkbackward.

Includeany/allperiodsofUnemploymentandany/allperiodsofSelfEmployment

EmployedFrom

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EmployedTo NameofEmployer