Fillable Vendor License Application Packet 17

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Vendor License Application Packet 17

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File type: PDF

U.S.A. forms for City of Oak Park

BROWSE CITY OF OAK PARK (MI) FORMS

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CITY OF OAK PARK
MICHIGAN
PERSONAL LICENSE
(Hawkers or Peddlers of Food or Food Products)
___________________________________________ _________________________________________
Name Phone Number
___________________________________________ _________________________________________
Home Address License No.
___________________________________________ _________________________________________
City, Zip Code Birth Date
Citizen of United States:_______________________ Birth Place:________________________________
Have you ever been convicted of a felony and/or misdemeanor?________________________________________________
If so, place and date___________________________________________________________________________________
Are you on parole or probation as a result of such violation?___________________________________________________
Are you addicted to the use of intoxicating liquor or drugs?____________________________________________________
Education: School_______________________ Grade Completed____________________________
State place, occupation and starting/ending dates of employment during past five years:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Type of products to be vended by licensee and name of manufacturer or supplier of said products:
_____________________________________________________________________________________________________
Description of vehicle(s) and/or container checked by health officer to be used:
_______________________________________ __________________________________________
1
st
Vehicle – Make, Model & Year 2
nd
Vehicle – Make, Model & Year
Vin. No.________________________________ Vin. No.___________________________________
Mich. Lic. Plate #_________________________ Mich. Lic. Plate #____________________________
This application for license must be accompanied by two (2) photographs of licensee of passport size and type, a health certificate
issued by the Department of Health for Oakland County stating that applicant is free from any contagious and/or infectious disease;
and a Food Handlers Permit showing the applicant to be a licensed food handler (Food Handlers Permit does not apply to prepacked
foods).
All licenses issued and/or granted shall expire at midnight the following April 30
th
of each year, and shall be an annual license.
I hereby swear or affirm that I am fully aware of the duties and obligations of persons engaged in the business indicated above and
agree to comply with the state laws, city charter, city ordinances and such rules and regulations as may now or hereafter be in effect
relating to the operation of said business, and the statements contained in this application are true to the best of my knowledge and
belief.
Food Handlers Permit_________________________ __________________________________________
Date Signature of Applicant
Veteran’s Exemption No.______________________ __________________________________________
Home Address
License No.______________ Plate No.___________ __________________________________________
City, State, Zip Code
Issued______________________________________
Department of Public Safety Records Checked By____________________________________________________________
VENDPER.LIC
CITY OF OAK PARK
MICHIGAN
VEHICLE AND/OR CONTAINER LICENSE
(This License Covers Foods Other Than Milk or Milk Products)
______________________________________ OR _______________________________________
BUSINESS NAME INDIVIDUAL NAME
______________________________________ _______________________________________
STREET ADDRESS HOME ADDRESS
______________________________________ _______________________________________
CITY, ZIP CODE CITY, ZIP CODE
______________________________________ _______________________________________
PHONE PHONE
IF PARTNERSHIP, GIVE NAMES AND ADDRESSES OF EACH PARTNER; IF FIRM OR CORPORATION,
GIVE NAMES OF OFFICERS:
NAME HOME ADDRESS (Full) TITLE
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
IS STATE SALES TAX REQUIRED? YES _____ NO _____
I/WE HAVE A STATE SALES TAX LICENSE NUMBER __________________
I/WE HAVE MADE APPLICATION FOR A STATE SALES TAX NUMBER YES _____ NO _____
DESCRIPTION OF VEHICLE(S) AND/OR CONTAINER CHECKED BY HEALTH OFFICER TO BE USED:
______________________________________ _____________________________________
1st Vehicle - Make, Model & Year 2nd Vehicle - Make, Model & Year
Vin. No.______________________________ Vin. No._____________________________
Mich. Lic. Plate #____________________ Mich. Lic. Plate #___________________
MARK "X' IN BOX FOR TYPE OF LICENSE DESIRED:
ICE CREAM VENDOR __________ FRUITS AND/OR VEGETABLES __________ OTHER __________
I HEREBY SWEAR OR AFFIRM THAT I AM AUTHORIZED TO MAKE TRANSACTIONS FOR THE FIRM
OR INDIVIDUAL NAMED HEREIN; THAT I AM AT LEAST TWENTY-ONE YEARS OF AGE; THAT I AM
FULLY AWARE OF THE DUTIES AND OBLIGATIONS OF PERSONS ENGAGED IN THE BUSINESS
INDICATED ABOVE AND AGREE TO COMPLY WITH THE STATE LAWS, CITY CHARTER, CITY
ORDINANCES AND SUCH RULES AND REGULATIONS AS MAY NOW OR HEREAFTER BE IN EFFECT,
RELATING TO THE OPERATION OF SAID BUSINESS, AND THAT THE STATEMENTS CONTAINED IN
THIS APPLICATION ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF.
Food Handlers Permit _________________ _____________________________________
Date Signature of Applicant
Veteran's Exemption No. ______________ _____________________________________
Home Address
License No. _______ Plate No. ________ _____________________________________
City, State, Zip Code
Issued _______________________________
YEARLY LICENSE FEES: Motorized Vehicle $50.00
Non Motorized Vehicle (Bicycle) $15.00
Personal $15.00
VENDVEH
.
LIC
FOOD VENDOR
APPLICATION INSTRUCTIONS
1. Complete both application
forms: Personal
License
and
Vehicle/Container
License.
2.
Provide the following
with
your
application forms:
tr Copy of
Driver's License for each driver
E Driving record
for each
person who
will be driving licensed
vehicle(s)
(obtain
from Secretary of State)
tr Copy of driver's license or
other
govemment-issued
identification for any
other workers to enable
a background check
E
Registration for each
vehicle
D Certihcate
of insurance
for
each
vehicle
tr Oakland County
Health
Department inspection report
E Two small
photo's
(such
as a
passpo(
photo)
3. Pay non-refundable
fee at Treasury Office:
$50.00
4. Submitted
completed application
forms,
paperwork
listed above and receipt for
payment
from Treasury Office to the City Clerk.
The application
process
can take anywhere from a few days to
a
few weeks. Both
paper
license and license
plate(s) will
be
mailed
after approval by the Department olPublic
Safety.
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Vendor License Application Packet 17

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Completed 6 November 2019

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