Form: secondhand-article-dealer-license-application

Home » Government » License and Permit Applications » Form: secondhand-article-dealer-license-application

Secondhand Article Dealer License Application

Fee: $27.50

License Term: January 1st thru December 31st

Name of Licensed Establishment

Address of Licensed Establishment

Street Address

Address of Licensed Establishment

City

State/Province

Zip/Postal

Business Phone Number

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

Applicant Name

First

Middle

Last

Applicant Phone Number

Applicant Address

Street Address

Applicant Address

City

State/Province

Zip/Postal

Applicant Driver's License Number

Applicant Date of Birth

Upload Picture of Applicant's Driver's License

Maximum file size: 52.43MB

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

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, 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, 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, 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, nature of the offense and conviction information:

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

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.

Signature

Clear

Date

If you are human, leave this field blank.

Secondhand Article Dealer License Application

Contact Us