Village Clerk Fee: $50.00 Rec. #
Village of Caledonia
County of Racine Registration/License #
Person, Firm, Association or Corporation Information:
(1) Business name, address & telephone number:
(2) Your name, home address & telephone number:
(3) Temporary address and telephone number from which business will be
(4) Nature of business to be conducted and a brief description of the merchandise,
and any services offered:
(5) Proposed methods of delivery of merchandise, if applicable:
(6) Make, model and license number of any vehicle to be used by applicant in the
conduct of his/her business:
(7) Most recent cities, villages, Villages where applicant conducted his/her business
(not to exceed three):
(8) Place where applicant can be contacted for at least seven days after leaving the
(9) Has applicant been convicted of any crime or ordinance violation related to
applicant’s transient merchant business within the last five years -- if so, the nature
of offense and the place of the conviction?
The applicant agrees to comply with and be bound by all the laws, ordinances, rules, regulations and
penalties governing the business for which this license is applied for.
Copy of documents required:
1. Driver’s License or proof of identity;
2. A State Health Officer’s Certificate***;
3. A state certificate of examination & approval from the sealer of weights & measures where
applicant’s business requires use of weighing & measuring devices approved by state
4. Two (2) color photographs that is no larger than 2” x 2” (“passport sized”), unless a larger
photograph is deemed acceptable by the clerk
***Where the applicant’s business involves the handling of food or clothing and is required to be certified
under state law; such certificate to state that applicant is apparently free from any contagious or infectious
disease, dated not more than 90 days prior to the date the application license is made.
(Please Turn Over)
Permanent Personal Information
(Print Name)
Home Phone No.
Contact Phone No.
(Home Address)
(City, State and Zip)
DL # or ID# SS #
Current ID INFO.:
Age Height Weight Hair Color Eye Color
Subscribed and sworn to before me
this day of 20
Notary Public, Racine County, WI
My Commission Exp.:
For Office Use Only
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P:\Transient App..doc
Revised: 9/11/15
All questions are answered
All personal information is filled out completely (including backside)
Documents attached:
Copy of Driver’s License or other proof of ID
A state certificate of examination and approval of weights and measures
A State Health Officer’s Certificate
Two (2) color photographs as specified