05-27-2003 Council Packet - Laserfiche WebLink

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Application for Peddler or Transient Merchant License Clicck One: Peddler Transient Merchant Fee: $100.00 Date Received: Applicant Information Legal Name: First Middle Last MN Driver's License Number (or other valid form of legal identification) - attach copy; Other names under which applicant conducts business; Permanent address; Sueet State Zip Telephone number of permanent address; Have you served a sentence in jail or prison or been convicted of a felony, gross misdemeanor or misdemeanor within the last five years for violation of any state or federal statute or any local ordinance, other than traffic offenses? You may answer "No" if the conviction or criminal records have been annulled, sealed, set aside, cr purged, or if you have been pardoned pursuant to the law.____No ____Yes If'Yes", please specify._______________________________________________________________ Business Information Full name of any and all business operations owned, managed or operated by applicant, or for which the applicant is an employee or agent:_____________________________________________________ Applicant's regular place of business (if any): Business-related telephone numbers:_____ Type of business: Description of items to be sold or services to be provided: Dates to conduct business (maximum 10 days): Address and telephone number where applicant can be reached while conducting business within the City: Address: ______________________________________________________________ street city/state Telephone: Three most recent locations where applicant has conducted business: Address: ______________________________________ street city/state Address: Address: Street city/state street city/state 2750 Kelley Pirkwiy. P.O. Box 66, Crystal Bay, MN 55323 Phone: 952-249-4600 / Fax: 952-249-4616/wwwxitmmo.fiiLiis