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Town Of North Hempstead (TOWN OF NORTH HEMPSTEAD)

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Chapter 40 Peddler/Solicitor Application – Revised 9/2010 lcg/tc Page 1 of 5
Town Of North Hempstead
Office of the Town Clerk
200 Plandome Road Manhasset, NY 11030
CHAPTER 40
APPLICATION FOR LICENSE - PEDDLER/SOLICITOR
LICENSE TYPE:
NEW
X
RENEWAL
CLASS:
PEDDLER
CORPORATION OR TRADE NAME
INDIVIDUAL
PARTNER
CORP
ADDRESS
NAME OF APPLIACANT
TELEPHONE NO.
ADDRESS
POSITION
LIST NAMES, ADDRESSES AND SOCIAL SECURITY NUMBERS OF ALL OFFICERS, PARTNERS
PRESIDENT OR
INDIVIDUAL
NAME IN FULL
SOCIAL SECURITY NUMBER
ADDRESS
V.P. OR PARTNER
NAME IN FULL
SOCIAL SECURITY NUMBER
ADDRESS
SECRETARY OR
TREASURER
NAME IN FULL
SOCIAL SECURITY NUMBER
ADDRESS
HAVE ANY OF THE (INDIVIDUALS) OFFICERS LISTED ABOVE
OR SHAREHOLDERS BEEN CONVICTED OF A FELONY OR
MISDEMEANOR?
YES
NO
IF YES, WHAT CRIME?
WHEN?
PENALTY ASSESSED
DATE
VIOLATION
NAME & LOCATION OF COURT
PENALTY IMPOSED
LIST BELOW ALL MUNICIPALITIES YOU CURRENTLY HOLD LICENSES WITH FOR THE CONDUCT OF YOUR BUSINESS
MUNICIPALITY
LICENSE NUMBER
MUNICIPALITY
LICENSE NUMBER
MUNICIPALITY
LICENSE NUMBER
B. CITIZENSHIP OF OWNERS, OFFICERS OR PARTNERS
PRESIDENT OR
INDIVIDUAL
IS THIS OFFICER A CITIZEN OF THE
UNITED STATES?
YES
NO
BY
BIRTH?
YES
NO
DATE OF BIRTH:
BY
NATURALIZATION?
YES
NO
DATE OBTAINED:
PLACE OBTAINED:
V.P. OR
PARTNER
IS THIS OFFICER A CITIZEN OF THE
UNITED STATES?
YES
NO
BY
BIRTH?
YES
NO
DATE OF BIRTH:
BY
NATURALIZATION?
YES
NO
DATE OBTAINED:
PLACE OBTAINED:
Wayne H. Wink, Jr.
Town Clerk
(516) 869-7646
Telephone
Chapter 40 Peddler/Solicitor Application – Revised 9/2010 lcg/tc Page 2 of 5
SECRETARY OR
TREASURER
IS THIS OFFICER A CITIZEN OF THE UNITED
STATES?
YES
NO
BY
BIRTH?
YES
NO
DATE OF BIRTH:
BY
NATURALIZATION?
YES
NO
DATE OBTAINED:
PLACE OBTAINED:
C. BUSINESS PAPERS
CERTIFICATE OF REGISTRATION WITH NYS DEPARTMENT OF STATE?
YES
NO
IF YES, INCLUDE COPY AND INDICATE FEDERAL/STATE IDENTIFICATION #
ID#:
IF NO, APPLICANT MUST SHOW PROOF OF APPLICATION TO NYS DEPT. OF STATE
DATE FILED:
COPY INCLUDED ?
CERTIFICATE OF AUTHORITY FROM NYS DEPARTMENT OF TAXATION & FINANCE?
YES
NO
IF YES, INCLUDE COPY
CERTIFICATE OF REGISTRATION OF D/B/A NAME WITH NASSAU COUNTY CLERK?
YES
NO
IF YES, INCLUDE COPY
FOREIGN CORPORATIONS (OUT OF STATE) CERTIFICATE OF AUTHORITY TO DO
BUSINESS IN NEW YORK STATE, ISSUED BY NYS DEPT. OF STATE?
YES
NO
IF YES, INCLUDE COPY
NAME OF OWNER OR CORPORATE OFFICER UPON WHOM PROCESS AND/OR LEGAL NOTICE CAN BE SERVED
NAME:
TELEPHONE NO.
LOCAL ADDRESS:
D. BUSINESS CLASSIFICATION OR SERVICE TYPE? (NATURE OF BUSINESS)
TYPE BUSINESS:
GOODS OR SERVICES TO BE PEDDLED OR ITEM SOLICITED?
E. NAME (S) AND ADDRESS OF SUPPLIERS
1.
TELEPHONE NO.
ADDRESS:
2.
TELEPHONE NO.
ADDRESS:
3.
TELEPHONE NO.
ADDRESS:
F. REQUIREMENTS – COMPANY EMPLOYEES
IF APPLICATION IS BEING MADE BY COMPANY EMPLOYEE INCLUDE THE FOLLOWING:
COMPANY IDENTIFICATION
COPY INCLUDED
LETTER INDICATING TERMS OF EMPLOYMENT, BUYER/SELLER OR CONTRACT AGREEMENTS
COPY INCLUDED
IF PEDDLER VEHICLE IS LEASED, INCLUDE COPY OF LEASE AND/OR CONTRACT STIPULATING LEASING ARRANGEMENT
COPY INCLUDED
VEHICLE TITLE HOLDER?
NAME OF OWNER
ADDRESS
G. REGISTRATION PEDDLER VEHICLES
YEAR
MAKE
BODY TYPE
PLATE #
VIN#
ARE DMV REGISTRATIONS INCLUDED FOR EACH VEHICLE?
YES
NO
NUMBER OF VEHICLES
H. INSURANCE REQUIREMENT
PUBLIC LIABILITY
SPECIFY AMOUNT
$
PERSONAL INJURY
SPECIFY AMOUNT
$
PROPERTY DAMAGE
SPECIFY AMOUNT
$
Chapter 40 Peddler/Solicitor Application – Revised 9/2010 lcg/tc Page 3 of 5
ARE INSURANCE CERTIFICATES INCLUDED FOR EACH VEHICLE?
YES
NO
COVERAGE ON VEHICLES MUST BE MAINTAINED FOR THE FULL LICENSING PERIOD. INSURANCE CERTIFICATES MUST BE
FORWARDED TO THE OFFICE OF THE TOWN CLERK, TOWN OF NORTH HEMPSTEAD BY THE APPLICANT’S/VEHICLE
OWNER’S INSURANCE PRODUCER. THE TOWN OF NORTH HEMPSTEAD MUST APPEAR AS THE CERTIFICATE HOLDER AND
MUST RECEIVE 30 DAYS WRITTEN NOTICE OF CANCELLATION FROM THE ISSUING COMPANY. ALL POLOCIES MUST BE
ISSUED BY INSURANCE COMPANIES RECOGNIZED BY THE NEW YORK STATE INSURANCE DEPARTMENT AND LICENSED
TO DO BUSINESS IN THE STATE OF NEW YORK.
I. VETERAN’S EXEMPTION
ARE YOU AN HONORABLY DISCHARGED VETERAN OF THE ARMED SERVICES OF THE UNITED STATES?
YES
NO
IF YES, HAVE YOU OBTAINED A VETERANS LICENSE FROM THE NASSAU COUNTY CLERK TO HAWK, PEDDLE, VEND
OR SOLICIT?
YES
NO
COPY OF NASSAU COUNTY VETERANS LICENSE ATTACHED?
YES
NO
VETERANS POSSESSING SUCH LICENSE ARE EXEMPT FROM PAYMENT OF FEES FOR THE TOWN OF NORTH HEMPSTEAD
LICENSE.
J. ADDITIONAL REQUIREMENTS
IF THE APPLICANT FOR A LICENSE IS TO HANDLE FOOD IN ANY FORM, THEY ARE REQUIRED TO SUBMIT WITH THE
APPLICATION EVIDENCE THAT THEY HAVE COMPLIED WITH THE PROVISIONS OF THE NASSAU COUNTY PUBLIC HEALTH
ORDINANCES AND LOCAL LAWS.
COPY OF NASSAU COUNTY DOH FOOD HANDLERS PERMIT ATTACHED?
YES
NO
IF THE APPLICANT FOR A LICENSE USES SCALES OR MEASURES IN THE BUSINESS, IT IS REQUIRED THEY ALSO FILE
WITH THE APPLICATION A CERTIFICATE ISSUED BY THE NASSAU COUNTY SEALER OF WEIGHTS AND MEASURES THAT
HIS SCALES OR MEASURES HAVE BEEN TESTED AND SEALED.
COPY OF NASSAU COUNTY DEPARTMENT OF WEIGHTS AND MEASURES PERMIT ATTACHED?
YES
NO
FINGERPRINTS TAKEN FOR CRIMINAL JUSTICE
SERVICES? (NEW APPLICANTS ONLY)
YES
NO
THREE (3) INDIVIDUAL PHOTOGRAPHS 2” X 2” TAKEN WITHIN SIXTY
(60) DAYS OF THIS APPLICATION.
YES
NO
K. WORKER’S COMPENSATION OR IF YOU ARE A SOLE
PROPRIETOR, PROVIDE A WAIVER OF WORKER’S COMPENSATION
L. NEW APPLICANTS ONLY
ALL NEW APPLICANTS FOR A LICENSE MUST CONSENT TO BEING FINGERPRINTED AT THE DIRECTION OF THE TOWN
CLERK AND MUST PAY THE COSTS OF SECURING AND REVIEWING THE FINGERPRINTS
1. Scheduling appointment for fingerprinting, can be done 24/7/365 via the L-1 Enrollment Services website. Go to
www.L1enrollment.com or call toll free (877)-472-6915. Scheduling through the call center is available 9AM – 9PM, Monday through
Saturday. When making your appointment select the nearest or most convenient location. Available locations can be found by
selecting “NY” and then click on “Locations” to view the listings. You will need the ORI# & reason shown above when making
appointment.
TOWN OF NORTH HEMPSTEAD
ORI #
NY029071Y
FINGERPRINT REASON
PEDDLER/ SOLICITOR
2. You must bring two (2) forms of identification, one of which must be a photo ID to the L-1 center. Acceptable forms are a driver’s
license, current US Passport, your Social Security Card; etc…
They are indicated on the L-1 website.
Chapter 40 Peddler/Solicitor Application – Revised 9/2010 lcg/tc Page 4 of 5
THE ANNUAL FEE OF $50.00 FOR EACH PERSON AND $50.00 FOR EACH VEHICLE IS ASSESSED FOR THE PERIOD OF FEBRUARY 1ST TO
JANUARY 31ST. THERE IS NO REDUCTION IN FEES FOR FRACTIONAL PARTS OF A YEAR OR REFUND IF THE APPLICANT FAILS TO
QUALIFY FOR LICENSING UNDER THE TERMS OF THE ORDINANCE. FEE(S) ARE CONSIDERED FILING CHARGES.
FOR YOUR APPLICATIONS TO BE PROCESSED, ALL OF THE REQUESTED ITEMS MUST BE RETURNED TO THIS OFFICE.
INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED.
IF YOU HAVE ANY QUESTIONS, PLEASE CALL (516) 869-7654 OR 7655
LICENSE FEES
EACH PERSON
$50.00
X
=
EACH COMMERCIAL/SUBURAN
VEHICLE
$50.00
X
=
TOTAL DUE
I SOLEMNLY SWEAR TO THE TRUTH OF ALL STATEMENTS HEREIN AND AGREE TO ADHERE TO THE RULES AND
REGULATIONS OF CHAPTER 40, THE CODE OF THE TOWN OF NORTH HEMPSTEAD, THE NASSAU COUNTY CHARTER OF
AND THE LAWS OF THE STATE OF NEW YORK.
SIGNATURE
DATE
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Chapter 40 Peddler/Solicitor Application – Revised 9/2010 lcg/tc Page 5 of 5
This peddlers and/or solicitors license is valid in the unincorporated areas of the Town of North Hempstead. Incorporated villages
may have their own regulations applicable to peddlers and solicitors. It is advisable to check with each of the following villages prior
to attempting to peddle or solicit within their jurisdiction.
Village of Baxter Estates 516-767-0096
Village of East Hills 516-621-4251
Village of East Williston 516-746-0782
Village of Floral Park 516-326-6300
Village of Flower Hill 516-627-2253
Village of Great Neck 516-482-0019
Village of Great Neck Estates 516-482-8283
Village of Great Neck Plaza 516-482-4500
Village of Kensington 516-482-4409
Village of Kings Point 516-482-7872
Village of Lake Success 516-482-4411
Village of Manorhaven 516-883-7000
Village of Mineola 516-746-0750
Village of Munsey Park 516-365-7790
Village of New Hyde Park 516-354-0022
Village of North hills 516-627-3451
Village of Old Westbury 516-626-0800
Village of Plandome 506-627-1748
Village of Plandome Heights 516-627-1136
Village of Plandome Manor 516-627-3701
Village of Port Washington North 516-883-5900
Village of Roslyn 516-621-1961
Village of Roslyn Estates 516-621-3541
Village of Roslyn Harbor 516-621-0368
Village of Russell Gardens 516-482-8246
Village of Saddle Rock 516-482-9400
Village of Sands Point 516-883-3044
Village of Thomaston 516-482-3110
Village of Westbury 516-334-1700
Village of Williston Park 516-746-2193
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Completed 14 July 2020

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