Form: pawnbrokers-license-application

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Pawnbroker's License Application

Fee: $210.00

License Term: January 1st thru December 31st

Name of Establishment:

Business Phone Number

Address of Licensed Premises

Street Address

Address of Licensed Premises

City

State/Province

Zip/Postal

Business Owner's Information (Corporation / LLC / Partnership Name):

Business Owner's Phone Number

Business Owner's Address:

Street Address

Business Owner's Address:

City

State/Province

Zip/Postal

List Names, Addresses, Dates of Birth of all other Officers / Directors / Partners:

Applicant Name:

Applicant Phone Number

Applicant Address

Street Address

Applicant Address

City

State/Province

Zip/Postal

Applicant Driver's License Number

Applicant's Date of Birth

Upload Picture of Applicant's Driver's License

Maximum file size: 52.43MB

Have you or any other person listed on this application been convicted of a felony within the last ten (10) years?

Yes

If Yes, provide year of arrest and nature of the offense and conviction information:

Have you or any other person listed on this application been convicted of a misdemeanor within the last five (5) years?

Yes

If Yes, provide year of arrest and nature of the offense and conviction information:

Have you or any other person listed on this application been convicted of a statutory violation punishable by forfeiture within the last five (5) years?

Yes

If Yes, provide year of arrest and nature of the offense and conviction information:

Have you or any other person listed on this application been convicted of a county or municipal ordinance violation within the last five (5) years?

Yes

If Yes, provide year of arrest and nature of the offense and conviction information:

I understand that this license may be denied or revoked for fraud, misrepresentation or false statement contained in the application or for any violation of WI Stat §134.17, §943.34, §948.62, or §948.63.

Under the provisions of the Village of Fox Crossing Municipal Code, I hereby apply for a License for said business to be conducted on the aforementioned premises in Fox Crossing.

Signature

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Date

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Pawnbroker's License Application

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