Agenda - Council - 06/22/2004 - Laserfiche WebLink

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List below an'), felonies or gross misdemeanors or any crimes of lheft or issuance of o worthless check of Which you were convicted of, within the ten (10) most recent ',/earS'and the nature of i'he crime or crimes of which you were convicted: 17) Have you taken advantage of any Slate or Federal bankruptcy or insolvency law or proceeding as a bankrupt or debtor ,,vithin the ten (10) most recent years? /,,-'~ o . If yes, explain: List below FULL names, dates of birth, and driver's license numbers and Slate of Issue of all employees other than the above applicant who will be selling these goods in the City of Ramsey: 191 Do you reside in, Ramsey and have your home asabase for your business? Yes: If yes, who1 is the presenl zoning of the property?' If you resale within the city hm~t, of Kamsey and youth'.principal place of I~uslness is at your home, you may be sublecl to certain zoning regulations and you may have to apply for a cond~honal use perm& 20) Please list other cities you hove conducted business in: ?-\~-". O (~- ~ ~- , ''j--'-7 ,'2 I) Please fill out COMPLETELY the attached forms that are required for the Minnesota DeparTment of. Revenue and Department of Labor and Industry. ,Some of this information may be repetitive, but it is required by Minnesota Statute Sections 270.72 and 176.18'2. Applications will not be accepted until these forms are filled out completely. 22/ in order to permit the verification of the information required by City Code, any person required to submit information as herein set Iorth shall not engage in selling or in making calls as described in the City Code until seven (?1 days have elapsed after submitting the application. Licenses are good for the calendar year and must be renewed each year. The LICENSE FEE OF $1013.00 shall be paid at the time of application. Also required Js proof of insurance for your company. I hereby certify tho1 the foregoing ~latements are true and correct to the best of my knowledge and that the giving of false information or the failure to give pertinent nformat on constitutes cause for revocation of this permit. Further, I agree to comply with all the p~rovisions of the ordinance undemwhich this license is granted. Applicant's Signcture: ,. c-'~.~2... ,=. "' ,'- -~. . / ,~ Date: (-( '/'f ~; u This license will take effect as early as January 1, 2004 and will expire on December 31, 2004, The license fee of S1 O0.00 must be paid at the time of application. DO NOT WRITE BELOW THIS LINE-FOR CITY USE ONLY 4::.,: -C- d Receipt# . //~ ~._ I Approved on Zoning Approval