CITY OF HOWELL

APPLICATION FOR PEDDLERS LICENSE, SECTION 872

Approval of this application is subject to investigation and clearance by the Howell City Police Department; the issuance of the license, if so approved, will be by the Howell City Clerk’s office.

NOTE: ALL questions must be answered and for those items that are “not applicable,” “N/A” shall be placed in the space provided. If more space is needed to completely answer any question, attach additional sheets as necessary.

PART I

A.1.What is the name of the business?

  1. County and state where DBA is registered:

County State

(Attach copy of DBA or Article of Incorporation)

  1. Federal Tax Identification No. or Social Security No.

---

  1. What is the full address of the business?

, ,

City State Zip Code

  1. What is the phone number of the business? --

B.1.The full name of the applicant:

  1. The residence address of the applicant:

, ,

CityStateZip Code

  1. The date of birth of the applicant: ,
  1. Do you own the business that is the subject of this application?

Yes No

C.1.The full name of the principal or owner of the business, if applicant is

acting as the agent:

PART II

A.Describe the type(s) of articles to be sold or offered to be sold:

B.Describe the method of sale (door to door, vehicle, street corner):

PART III

Describe the type of vehicle(s) that will be used in the operation:

MAKE:

MODEL:

YEAR:

Attach Current proof of insurance.

PART IV

License plate number(s):

PART V

State where the plates are registered:

PART VI

Is the vehicle to be used as a personal vehicle or company vehicle?

PersonalCompany

(If more than one vehicle is to be used, fill in the information required in PART III on the back of this form.)

PART VII

Are you a citizen of the United States? Yes No

If no, do you have a valid alien registration card? Yes No

What is the ID number of the alien registration card?

Your driver’s license number: -

PART VIII

Have you ever been convicted of violating a law of the State of Michigan or of the United States or of any ordinance of the City of Howell or any other city in the country?

Yes No _____

If yes, the applicant shall include the details of such conviction(s):

PART IX

The license applied for is requested to begin , and end ,.

(Note: License will expire December 31st of the current year.)

PART X

Are you claiming exemption from license fees (non-profit charitable organization)?

Yes No

If yes, an affidavit containing such facts must be attached to this application.

PART XI

As a further condition to the issuance of this license, the applicant agrees to allow or do the following:

  1. Have the vehicle(s) to be used in the operation inspected by the Howell City Police at any time that the license is in effect to determine that said vehicle(s) complies with any state law or local ordinance and to correct any violations found.
  1. Furnish upon request to the Howell City Police Department the routes that will be followed by the applicant in the course of his/her vending.

C. Authorize a background search of any criminal history records and/or driving records.

PART XII

I, the undersigned, hereby swear or affirm that the above statements are true to the best of my knowledge and belief and understand that any false statements or significant omissions shall be grounds for denial of a license.

______

DateSignature of Applicant

Signature of Witness ______

______

Date

Required documents to be submitted with application for Peddlers License:

Copy of DBA or articles of incorporation

Copy of Michigan Sales Tax License (not required for the sale of food)

Health Card for food related vending

Evidence of 501(C)(3) designation if non-profit and claiming exemption from fees.

Executed release form for background check & driving record

Proof of Insurance

Cash deposit of $500 (returned after license has expired) or a surety bond for $500

$100 application fee

**PROCESSING OF PEDDLER’S PERMIT APPLICATIONWILL TAKE A MINIMUM OF TEN (10) WORKING DAYSAFTER ALL REQUIRED DOCUMENTS HAVE BEEN PROVIDED.**

FOR CITY USE ONLYCHECK ONE

ATTACHMENTS:

A.Exemption Affidavit Yes ____ No ____

B.Driving Record Yes ____ No ____

C.Criminal History Yes ____ No ____

D. Proof of Insurance Yes ____ No ____

E.Cash Deposit or surety bond Yes_____No_____

F.Application Fee Yes_____No_____

G.All form questions answered Yes ____ No ____

H.Other (specify) Yes ____ No ____

Recommendation by Chief of Police: ______

______

Chief of Police

______

Date

License Fee $50.00

Date Paid: ______

Date License Issued: ______

______

City Clerk

Amended 2/28/07Page 1 of 5