Brandt, DavidAOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni 17,
Lynn O'Dell
w.
,T wn of app ng;�-
application for Hawkers
eceived &Meddler's License
License for Hawking and Peddling pursuant to Town of Wappinger Local I law Nn i n of i Qw)
regulating Hawkers and Peddlers in the Town of Wappinger, and in connec
application, does state the following: Addsom
1) Applicant:
NAME: -Q Q , � s"\ AGE.I.,
CURRENT ADDRESS:
(St #) (Street) (City) (State) (ZIP)
PHONE#
PERMANENT ADDRESS (if different):
(St 4) (Street) (City) (State) (ZIP)
If Applicant is an Agent or Employer:
Applicant's Empfoyer �"`
Address of Employer 't,
e ) (City) (State) (ZIP)
Proof of Employment attach to application)
2) Nature of Business:
Tape a 2"X 2"
color photo (less
than 60 days Old)
Motor Vehicle (circle one): < :.car ,) truck van
ir
On Foot &/or with vehicle drawn,by hand or animal
Vehicle Info: Vehicle Make
C"NVVehicle Model
,
License Plate # °;h __.. State of Registration
Operator's License Number
E' Weights & Measures Certificate Certificate
Ll Dutchess County Health Dept Permit Permit ## _
2021-05-13 JPP
3) Veteran Status
F1 Veteran Applicant - Exempt from license fee (attach certificate from Dutchess County)
Names of all other municipalities in which the applicant has been a vendor in the preceding 6
months:
4) Compliance
That the applicant, if the License requested hereby is granted, consents and agrees to conduct the
aforesaid business or activity pursuant to all of the terms and regulations of the Local Law above
specified, and all other rules, regulations and Laws governing ones activities in the Town of
Wappinger as a Peddler or Hawker.
Dated: ��_, 20
Wappingers Falls, N.Y. V
�ig^nature o Applicant
Sworn to before me this
ay of 1, 20 13
Notary Public
Lee A. Frena
Notary Public, State of New Yarm
No, OIFRO327313
Qualified In Outchess Ca}� n_�t�
Commission Expires 7161_
Application must be accompanied by a fee of Two Hundred Dollars ($200.00) plus $50 for
each addition to the original license per year, payable to the Town of Wappinger. This is a
non-refundable fee.
Applicants possessing a valid Dutchess County Veterans Vendors License are exempt from
the $200.00 fee, provided that a copy of said license is attached to the application.