Agenda - Council - 09/28/2004 - Laserfiche WebLink

Home

t6) Lid below (]ny felonies or gross misdemeanors or any crimes of theft or issuance of a worthless check of which you were convicted of within the ten I ] O) most recent years and the nature of the crime or crimes of which you were convicted: NONE 1 7) Have you laken advantage of any State or Federal bankruptcy or insolvency law or proceeding as a bankrupt or debtor within the fen (I O) most recent years? NO If yes, explain: 18) List below FULL names, dates of birth, and driver's license numbers and State of Issue of all employees other than the above applicant who will be selling these goods in the City of Ramsey: NA ] 91 Do you reside in RamseS, and have your home as a base for your business? Yes: No: X If yes, what is the present zoning of the property? If you reside within lhe city limits of Ramsey and your principal place of business is at your home, you may be subject to certain zoning regulations and you may have to apply for a conditional use permit.. 20) Please list other cities you have conducted business in: ANODOVER, COON RAPIDS, CHAMPLIN, MAPLE GROVE, HAM LAKE, EI..K RIVER, FOREST LAKE, BASICALLY ALL OF ANOKA COUNTY 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 176.182. 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 os herein set forth shall not engage in selling or in making calls as described in the City Code until seven (7) dc~ys have elapsed after submitting the application. Licenses are good for the calendar year and must be renewed each year. The LICENSE I~EE OE $'100.00 shall be paid at the time of application. Also require(:] is proof of insurance for your company. I hereby certify that the foregoing statements are flue and correct fo the best of my kno,;vledge .and that the giving of false information or the failure fo give pertinent information constitutes cause for revocation of this permit. Further, I agree to comply with all the provisions of the ordinance under which this license is granted. Applicant's Signolure: ERIC SOUTHERLAND Date: 9/21/2004 This license will fake effect as early as January 1, 2004 and will expire on December 31, 2004. The license fee of $100.00 must be paid at the time of application. DO NOT WRITE BELOW THIS LINE - FOR CITY USE ONLY Received on Receipt Il' Approved on Zoning Approval