BUSINESS or TRADE NAME:
BUSINESS LOCATION:
MAILING ADDRESS:
TELEPHONE NUMBER:
PRIMARY NATURE of
BUSINESS:
OWNERSHIP: Partnership Corporation Limited Liability Compan
y
Other Explain:
Does your partnership or corporation have other businesses in Fayette County?
No Yes List:
Name, address, and phone number for owner(s) of business
NAME:
ADDRESS:
PHONE:
NAME:
ADDRESS:
PHONE:
LEXINGTON FAYETTE URBAN COUNTY GOVERNMEN
T
SCRAP METAL DEALER APPLICATIO
N
(if different from above)
(please include zip)
NAME (including Maiden name where applicable): TITLE OR POSITION held in business:
HOME ADDRESS:
Area Code
Have you ever been arrested? Yes If 'Yes", complete following section: No
Date of arrest: Charge:
Location of arrest:
Disposition in Court:
*
Prov
i
d
i
ng
f
alse
i
n
f
ormat
i
on on any part o
f
th
i
s appl
i
cat
i
on
i
s grounds
f
or den
i
al o
f
th
i
s appl
i
cat
i
on.
Date:
Signature of Applicant
Subscribed and sworn to before me by
on this
My commission expires:
Record Check Completed
Officer / Clerk Date
DATE OF BIRTH:
PLACE OF BIRTH:
City or County State
This page is to be completed by the individual making application for a permit or license.
TELEPHONE NUMBER:
State of Issue
SOCIAL SECURITY NUMBER:
DRIVERS LICENSE NUMBER:
NOTARY PUBLIC
FOR OFFICIAL USE
day of
click to sign
signature
click to edit