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Peddler's Permit Application

2. Supply the information requested below for each person in your group. If there are more than six persons in your group, you must include same information for each additional person on a separate sheet. Permits must list each member of your group, and are not transferable.

   Supply the information requested below for each person in your group. If there are more than six persons in your group, you must include same information for each additional person on a separate sheet. Permits must list each member of your group, and are not transferable.

4. Name

5. Date of Birth
   Date of Birth

7. Name

8. Date of Birth
   Date of Birth

10. Name

11. Date of Birth
    Date of Birth

13. Name

14. Date of Birth
    Date of Birth

16. Name

17. Date of Birth
    Date of Birth

19. Name

20. Date of Birth
    Date of Birth

22. Additional Member Information

24. A photo copy of driver's license or other state issued photo I.D. for each participant must be attached to this application by the clerk.

    A photo copy of driver's license or other state issued photo I.D. for each participant must be attached to this application by the clerk.

26. Permit has been approved and is valid beginning at 8 a.m. on and ends and sunset on:
    Permit has been approved and is valid beginning at 8 a.m. on and ends and sunset on: Start Date

    —

    Permit has been approved and is valid beginning at 8 a.m. on and ends and sunset on: End Date

28. Permit fees were paid on:
    Permit fees were paid on:

29. In the amount of:

31. Applicant notified permit was approved/denied on:
    Applicant notified permit was approved/denied on:

33. Permit Denial

    1. Permit has been denied for reasons explained in attached notice

34. Notice

36. City Administrator

37. Chief of Police

Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field