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KYLE CONLEY
is an alltllorized tllIlIler i. Sollllweslem ProtlllCls.
- ISSU:: 2~f':~;1~2011
... Account: 1.1.61B384
~ I :. -, OSM: MfAllfL.NmtONY A En: 2742-32483
~ I -- I For......... Gal 1---..... AI dial ""'" 2011
MEMBER , BBaj _ .11"... CMo.li".1w _ dlal_.
~ · -~Ift. ""''''...,...'''''........,1__251-1931.
~ SellthwlStlnJ Company · 2451 AIrl... Way. Nashi'Je, TN 37214
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Serial #:
20]0-0]-15 JCM
Town of Wappinger
Application for Hawkers
J~':..J>eddler' S Lisense
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FOR INTERNAL USE ONL Y
Received by: Chris Masterson []
Christine Fulton :J
Sue Rose n
Date Received: / /
The undersigned does hereby apply to the Town of Wappinger Town Clerk for a
r-tNiw') RENEWAL TEMPORARY
~ (I weekend only)
license for Hawking and Peddling pursuant to Town of Wappinger Local Law No.1 0 of 1992,
regulating Hawkers and Peddlers in the Town of Wappinger, and in connection with such
application, does state the following:
1) Applicant:
NAME: ~ it- l-.,,\t
CURRENT A'6DRESS? L
101 ~;n.lt~ ~, 8JfT~1-'1 /VI
(St #) (Street) ( Ity) (State)
PERMANENT AOpRESS (if different):
3D'OI ,{1, ,;\JJe"ltL D DI,,,,,b,,, tLD bS103
(St #) (Street) City ) (State) (ZIP)
]f Applicant is an Agent or Employer: Tape a 2"X 2"
Applicant's Employer 504t\,r~r'l G?I'!'(2?J color photo (less
Address of Employer 'LLfSi ClAO'Y\ ./fii'7 P~.....ll<.- TN ~7Z Lfthan 60 days Old)
(St. #) (Street) (City) (State) (ZIP)
Proof of Employment (attach to application)
AGE: 7- \
Tape a 2"X 2"
color photo (less
than 60 days Old)
(ZIP)
2) Nawre ofB~iness:
X ,/',.,' f!: cl",- ~-f;.,",,-I [JO{)Ji-~ 5(,~ws<-,. -J~ Otll~ .-f;-fcS(\ ..-b
fi1/",-,I,(j L-t~ e- .ra~L"'" ~.L'> ~<<1P:>'- It 1tor)
/
I Motor Vehicle (circle one): car truck van
I On Foot &/or with vehicle drawn by hand or animal
Vehicle Info: Vehicle Make Vehicle Model
License Plate # State of Registration
Operator's License Number
,- Weights & Measures Certificate Certificate #
'- Dutchess County Health Dept Permit Permit #
3) Veteran Status
L Veteran Applicant - Exempt from license fee (attach certificate from Dutchess County)