1
TOWN OF RAMAPO
ROCKLAND COUNTY, N. Y.
APPLICATION FOR PEDDLING AND SOLICITING LICENSE
TO THE TOWN CLERK
TOWN OF RAMAPO
STATE OF NEW YORK )
COUNTY OF ROCKLAND ) SS:
TOWN OF RAMAPO )
I …………………………………………………………………………………………………….
RESIDING AT ………………………………………………………………………………………………
PLACE OF BUSINESS AT …………………………………………………………………………………
DO HEREBY UNDER OATH APPLY FOR A LICENSE PURSUANT TO THE PEDDLER AND
SOLICITOR LAW OF THE TOWN OF RAMAPO AND STATE AS FOLLOWS:
1. FULL NAME AND AGE OF APPLICANT WITH DATE OF BIRTH
……………………………………………………………………………………………………….
2. HOME ADDRESS AND TELEPHONE NUMBER …………………………………………
……………………………………………………………………………………………………….
3. BUSINESS ADDRESS ………………………………………………………………………...
……………………………………………………………………………………………………….
4. ARE YOU SELF-EMPLOYED? ……………………………………………………………...
IF NOT, INDICATE EMPLOYER’S NAME AND ADDRESS …………………………………..
……………………………………………………………………………………………………….
2
5. I AM A CITIZEN OF ………………………………………………………………………….
6. HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR? ………...
IF SO, DETAILS ARE AS FOLLOWS ……………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
……………………………………………………………………………………………………….
7. BRIEFLY DESCRIBE THE NATURE OF THE PARTICULAR BUSINESS, TRADE OR
OCCUPATION FOR WHICH THE LICENSE IS REQUIRED ………………………………
……………………………………………………………………………………………………….
………………………………………………………………………………………………………
8. INDICATE THE NUMBER AND KINDS OF VEHICLES TO BE USED IN CARRYING
OUT THE BUSINESS FOR WHICH LICENSE IS REQUIRED (INCLUDE MAKE AND
TYPE OF VEHICLE, INCLUDE LICENSE NUMBERS AND INSURANCE COMPANY)
……………………………………………………………………………………………………….
……………………………………………………………………………………………………….
……………………………………………………………………………………………………….
……………………………………………………………………………………………………….
9. DESCRIBE THE KIND OF GOODS, WARES, MERCHANDISE AND SERVICE FOR
WHICH YOU WISH A LICENSE …………………………………………………………….
……………………………………………………………………………………………………….
……………………………………………………………………………………………………....
……………………………………………………………………………………………………….
10. ARE ALL YOUR SALES FOR FUTURE DELIVERY? ……………………………………...
11. ARE YOU ENGAGED IN INTERSTATE COMMERCE? (SELLING FROM ONE STATE
TO ANOTHER)
………………………………………………………………………………………………….
IF SO, GIVE THE BASIS FOR THAT CLAIM ……………………………………………
……………………………………………………………………………………………………….
3
12. WOULD IMPOSITION OF THE NORMAL LICENSE FEE SERVE AN UNDUE
BURDEN ON YOUR INTERSTATE BUSINESS ACTIVITIES? ............................................
IF SO, HOW MUCH OF A FEE WOULD YOU BE ABLE TO PAY AND WOULD YOU
WANT THE TOWN CLERK TO ADJUST THE FEE ACCORDINGLY SO IT IS NO
LONGER BURDENSOME? ………………………………………………………………….
13. NAME AND ADDRESS OF THE PERSON, AND TELEPHONE NUMBER OF FIRM OR
CORPORATION YOU REPRESENT ………………………………………………………...
……………………………………………………………………………………………………….
14. IF PARTNERSHIP, NAMES, ADDRESSES AND TELEPHONE NUMBERS OF ALL
PARTNERS ………………………………………………………………………….................
……………………………………………………………………………………………………….
……………………………………………………………………………………………………….
15. IF CORPORATION, NAMES, ADDRESSES AND TELEPHONE NUMBERS OF BOTH
PRINCIPAL OFFICERS AND AGENTS ……………………………………………………
……………………………………………………………………………………………………….
……………………………………………………………………………………………………….
16. HOW LONG HAVE YOU BEEN IN THIS BUSINESS? …………………………………….
17. NAME, ADDRESS AND TELEPHONE NUMBER OF PERSON UPON WHOM LEGAL
NOTICES MAY BE SERVED WITHIN THE STATE OF NEW YORK …………………….
……………………………………………………………………………………………………….
……………………………………………………………………………………………………….
18. PLEASE INDICATE NAME, ADDRESS AND TELEPHONE NUMBER OF YOUR
IMMEDIATE SUPERVISOR ………………………………………………………………….
……………………………………………………………………………………………………….
19. LIST FIVE MUNICIPALIES IN WHICH YOU HAVE WORKED WITHIN THE PAST
TWELVE MONTHS …………………………………………………………………………...
……………………………………………………………………………………………………….
……………………………………………………………………………………………………….
……………………………………………………………………………………………………….
4
20. ARE YOU WILLING TO POST A BOND TO INSURE DELIVERY OF YOUR
PRODUCTS IF YOU WERE SO REQUIRED? ………………………………………………
21. ATTACHED HERETO ARE THREE (3) RECENT PHOTOGRAPHS (2X2) AND TWO (2)
FINGER PRINTS OF MY LEFT AND RIGHT HAND.
22. HAS THE TOWN OF RAMAPO EVER REFUSED OR REVOKED YOUR LICENSE?
…………………………………………………………………………………………………..
I AGREE THAT ANY LICENSE ISSUED HEREUNDER IS NULL AND VOID IF ANY
OF THE FOREGOING STATEMENTS ARE NOT TRUE, OR IF THERE HAS BEEN
ANY CONCEALMENT OF A MATERIAL FACT.
_______________________________________
SIGNATURE
SUBSCRIBED AND SWORN TO BEFORE
ME THIS …………..DAY OF
…………………………, 20………………..
____________________________________
TOWN CLERK
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome