Meriden Police Department
APPLICATION FOR
VENDOR SOLICITOR PEDDLER LICENSE
Date: ________________
GENERAL INFORMATION
Applicant Name (print) ________________________________________________________
Home Address ________________________ City ______________ State _____ Zip ______
Telephone(s): (H)_______________ (W)___________________ (C) __________________
Date of Birth ___________________ Social Security Number ________________________
Driver’s License # _______________________ State _____ Expiration Date _____________
Name of Employer or Business Name _____________________________________________
Business Address _____________________________________________________________
Describe the nature of the business or the goods to be sold: ____________________________
____________________________________________________________________________
Please provide the following for all vehicles to be used:
1. Make ____________ Model _____________ Year _____ Color _______ Reg. # _________
2. Make ____________ Model _____________ Year _____ Color _______ Reg. # _________
ADDITIONAL INFORMATION REQUIRED SEE PAGE 2
I hereby authorize and acknowledge that a criminal records check may be conducted by the
Meriden Police Department.
Signature of Applicant: ________________________________ Date: ___________________
To obtain Vendors License submit this completed application to:
MERIDEN POLICE DEPT., ATTN: RECORDS DIVISION, 50 W. MAIN ST., MERIDEN, CT 06451
Office use only Copy of Driver’s License Criminal Record Check
Fee Paid $ __________ on _______________.
Approved: _____ Denied: _____ Signature: ________________________________ Date: ________________
Meriden Police Department
APPLICATION FOR
VENDOR – SOLICITOR – PEDDLER LICENSE
Page 2
ADDITIONAL INFORMATION
Have you ever been ARRESTED for any drug violation? Yes No
If Yes, list the town in which the arrest occurred and the date
___________________________________ __________________
___________________________________ __________________
Have you ever been CONVICTED for any violation of any law? Yes No
If Yes, list all cases
Date Place (Town or City) Location of Court Offense/Crime Disposition
By signing this application I am acknowledging that I will obey all City ordinances, regulations and State of Connecticut
laws governing the activities covered by this application. I understand that violation of said ordinances, regulations or
laws may be grounds for immediate revocation of this permit.
Sec. 53a-157 CGS – FALSE STATEMENT : Class A Misdemeanor – A person is guilty of False Statement when he
intentionally makes a false written statement under oath or pursuant to a form bearing notice authorized by law, to the
effect that false statements made therein are punishable, which he does not believe to be true and which statement is
intended to mislead a public servant in the performance of his official function. False Statement is a Class A
Misdemeanor. The penalty for a Class A Misdemeanor is imprisonment for a term not to exceed one year, and a fine not
to exceed $1,000 or both a fine or imprisonment. (Sec. 53a-28(b), 53a-36 and 53a42)
I declare, under the penalties of False Statement, that the answers to the above are true and correct.
Must be signed in presence of Notary Public
Signature of Applicant: ________________________________ Date: ___________________
Subscribed and Sworn to before me this _____ day of _______________, 20___.
___________________________________________
Additional Requirements
Seal Required
1. Applicants must submit a current passport size photograph (2 x 2)
2. Copy of Driver’s License or State ID
3. Completed application; signed and notarized
4. Copy of Sales and Use Tax Permit
5. Copy of Certificate of Liability Insurance or $3,000 Surety Bond
6. $150 payment of Cash, Check or Money Order payable to “City of Meriden”
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