Rokitowski, StevenFOR. INTERNAL USE ONLY
Received by: Joseph P. Paoloni I J
Grace �
Robinson C
/
ro Date Received: /
Serial
POR1a68>� 00
Town of Wappinger
Application for Hawkers
Peddler's Lisense
6
The ,undersigned does hereby apply to the Town. of Wappinger Town Clerk fora
ItiTEW RENEWAL TElweek enF.�
only)
license for Hawking and Peddling pursuant to Town of Wappinger Local Law No. 10 of 1992,
regulating Hawkers and Peddlers in the Town of Wappinger, and in connecti� w7thus „c o
application, sloes state the following: y
1) Applicant:
'`
NAME: �'V t n el -1)
\ W Ill AGE:
CURRENT ADDRESS:
(St ) (street) (City) ( tat_)_.n_..(zip)
PERMANENT ADDRESS (if different):
(St ##) (Street) (City) ('State) (ZIP)
If Applicant is an Agent or Employer: Tape a 2" X 2"
Applicant's Employer . ower Home Remodeling Group ..m color photo (less
�.�.._...._ Dr Trumbull CT 06611 _...._... ... nW...._. than 60 days Old)
Address of Employer 60 Commerce
(St. #) ('Street)'. ..w .......(City). _..... (state) (ZIP)
Proof of Employment attach to a lication
2) Nature of Business:
M Motor Vehicle (circle one): car truck van
® On Foot &tor with vehicle drawn by hand or animal
License Plate _ � r \ Vehicle Model i 5 0
Vehicle Info: Vehicle Make � � State of Re istration
_...._
Operator's License Number 1014 -3(Z
� 1
__w_......... .
❑ Weights & Measures Certificate Ccrti%Date ## � 11
(7 Dutchess County Health Dept Permit Permit #
2010-01-15 JCM
3) Veteran Status
❑ 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:_S 20 2
Wappingers Falls, Y, Signature of Applicant
Sworn to before me this
$N LISA EINSIDLE1;
day of��� , 20Z Notary pNO,&jc I St to of New York
Qualified in Suffolk County
Noy Commission Expires Oct 18, 2025
Notary Public
Application must be accompanied by a fee of Two Hundred Dollars ($200.00), 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.
New York State Department of Taxation and Finance
Certificate of Authority
1de-aflcation number
j
23-303+708
(Use this number on all returns and correspondence)
Y
POWER HOME REMODELING GROUP, LLC
.2501 SEAPORT CSR STE 8110
CHESTED PA 19013-2.249
VALI A i ED
31261201
Dept of Tax
and Finance
is authorized to collect sales and use taxes under Articles 28 and 29 of the New York State Tax Law,
Nontransferable
This certHicate must be prominen#iy displayed at your place of business,
Fraudulent or other improper use of this cartiflcate will cause it to be revoked.
The certifloate may not be photocopied or reproduced.
PhQ"mpha - aapyrlphl of NYS empim state Crarelopment
40201091CIO098 11 88 - 08%635 P0000236-01 DTF-17-A (8110)
N