Fillable SECONDHAND MERCHANDISE DEALER LICENSE APPLICATION FOR (City of Longview)

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SECONDHAND MERCHANDISE 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
SECONDHAND MERCHANDISE DEALER LICENSE
LONGVIEW CITY ORDINANCE CHAPTER 70-60
$25.00 FEE FOR NEW LICENSE OR LICENSE RENEWAL
___ NEW LICENSE ___ LICENSE RENEWAL
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
RESIDENT PHONE: _____________________ DOB:___________________ AGE:_______
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 VIOLATION?
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
DO NOT WRITE IN THIS SPACE
LICENSE NO. __________________
APPROVE _____________ DATE ___________
ISSUED ________________ DATE ____________
DENIED _______________ DATE____________
2. HAVE YOU EVER BEEN CONVICTED OF A THEFT-RELATED OFFENSE OF A CLASS B
MISDEMEANOR OR ABOVE?
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)
3. DOES APPLICANT INTEND TO CARRY ON, ENGAGE IN, OR PERMIT ANY OTHER BUSINESS IN
THIS LICENSED LOCATION?
YES NO
IF YES TO THE ABOVE, EXPLAIN ___________________________________________________
____________________________________________________________________________
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 ________________
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
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SECONDHAND MERCHANDISE DEALER LICENSE APPLICATION FOR (City of Longview)

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Completed 3 August 2020

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