Form Center

2. 
3. FAIR/MARKET LICENSE APPLICATION
5. First Name*
6. Last Name*
8. Address*
10. City*
11. State*
12. Zip Code*
14. Telephone*
15. Email Address
17. Date of Birth*
18. Place of Birth*
20. Driver's License #*
21. State*
23. 
    

    HAVE YOU EVER BEEN CHARGED WITH OR CONVICTED OF ANY CRIME, TRAFFIC VIOLATION, OR VIOLATION OF A MUNICIPAL ORDINANCE (Excluding parking tickets)?

25. If YES, please provide the following: (Additional paper provided if needed)*

    1. Yes
    2. No
27. Date of Arrest
28. Arresting Agency
30. Offense
32. Date of Arrest
33. Arresting Agency
35. Offense
37. Date of Arrest
38. Arresting Agency
40. Offense
42. Signature*
43. Date*
47. Name of Civic, Non-Profit Organization*
49. Date(s) of Event*
50. Place of Event*
52. Address*
54. City*
55. State*
56. Zip Code*
58. Type of Items to be Sold*

60. OTHER MEMBERS WHO WILL BE WORKING AT THE EVENT:

62. Name
63. Telephone
65. Name
66. Telephone
68. Name
69. Telephone
71. Name
72. Telephone
74. Name
75. Telephone

77. We hereby certify that the following Event Manager (Member of the Organization) has been authorized by our organization to make this application:

79. Signature of the President*
80. Date*
82. Signature of the Secretary*
83. Date*
87. Received by:
88. Date
89. Sent to PD
91. PD Approval
92. Denial
93. Date
Leave This Blank:


95. 1. Receive an email copy of this form.
96. Email address

    This field is not part of the form submission.

97. Submit

* indicates a required field