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Business Forms

VILLAGE OF WESTVILLE

 

BUSINESS LICENSE APPLICATION

 

APPLICATION NO. __________    ANNUAL LICENSE FEE DUE MAY 1ST: $______

 

(PLEASE TYPE OR PRINT)

 

1.        Applicant’s Name:_______________________________________  PHONE (    )            

2.        Applicant’s Address                                                                                              

          City_________________________________          State_______  ZIP                         

3.        Length of resident at above address  ________years ____________months

4.        Applicant’s Date of Birth ___/___/___          Social Security No.                                   

5.        Marital Status ___________________          Name of Spouse                                     

6.        Citizenship of Applicant                                                                                        

7.        Business Name_________________________________________  PHONE (    )            

8.        Business Address                                                                                                

          City_________________________________          State_______  ZIP                         

9.        Length of Employment _________years _____________months

10.      All residences and addresses for the last three (3) years if different than above:

     ________________________________________________________________________

     ________________________________________________________________________

11.      Name and Address of employers during the last three (3) years if different than above:

     ________________________________________________________________________

     ________________________________________________________________________

12.      List the last three (3) municipalities where applicant has carried on business immediately    preceding the date of application:

     ________________________________________________________________________

13.      A description of the subject matter that will be used in the applicant’s business:

     ________________________________________________________________________

14.      Has the applicant ever had a license in this municipality?  [  ]  Yes   [  ]  No

          If so, when ______________________________________________________________

15.      Has a license issued to this applicant ever been revoked?     [  ]  Yes   [  ]  No

          If “yes”, explain: _________________________________________________________

16.      Has the applicant ever been convicted of a violation of any of the provisions of this Code, etc.?

          [  ]  Yes   [  ]  No      If “yes”, explain:                                                                   

     ________________________________________________________________________

17.      Has the applicant ever been convicted of the commission of a felony?  [  ]  Yes   [  ]  No

          If “yes”, explain:                                                                                                 

18.      LICENSE DATA:         Term of License                                                                    

                                        Fee for License $                                                                   

                                        Sales Tax Number                                                                 

                                        License Classification                                                              

19.      LIST ALL OWNERS IF LICENSE IS FOR LOCAL BUSINESS (PERMANENT):

                                                                                                                                 

                                                                                                                                 


OFFICIAL BUSINESS LICENSE

 

 

STATE OF ILLINOIS                 )

COUNTY OF VERMILLION        )  ss.

VILLAGE OF WESTVILLE          )

 

                                                            ILLINOIS SALES TAX NUMBER                  

 

 

TO ALL TO WHOM THESE PRESENTS SHALL BECOME GREETINGS:

 

          WHEREAS                                                                                                      , having complied with all the requirements of the laws of the State of Illinois and the ordinances of the Village of Westville, Illinois in this behalf made and required license is, by authority of the Village of Westville, Illinois given and granted to the                                                            to                                               at                                                                                                 in the Village of Westville, County of Vermillion, and State of Illinois, from the            date hereof until the                    day of                              , __, said                                                                             to be subject to all laws of the State of Illinois and all ordinances of the Village of Westville, Illinois, not in conflict therewith, which are now or hereafter may be in force touching the premises.

 

 

(L.S.)

 

          Given under the hand of the Mayor of the Village of Westville, County of Vermillion, Illinois and the seal thereof, this                      day of                    , ____.

 

 

                                                                                                                                 

                                                            MAYOR

                                                            VILLAGE OF WESTVILLE

 

COUNTERSIGNED:

 

 

                                                 

VILLAGE CLERK

VILLAGE OF WESTVILLE

 

(SEAL)

 

APPLICANT/FIELD CHECK

 

INFORMATION CARD

 

 
   

 


                                                                                                                                 

Name                                                             Location                  Date             Time

                                                                                                                                 

Residence Address                                          D.L.#

                                                                                                                                 

Business Address                                             Vehicle   Color   Yr.   Body  License   Info

                                                                                                                                 

Occupation                                                      Vehicle Modifications:

                                                                                                                                 

Social Security Number                                   

                                                                                                                                 

Race             Sex               Height

                                                                      Action Leading to Check:                      

Weight          Eyes             Hair                       

                                                                                                                                 

Complexion                       Date of Birth

                                                                                                                                 

Unusual Features:

                                                                                                                                 

                                                                      Comments:

                                                                                                                                 

 

                                                                                                                                 

 

                                                                                                                                 

 

                                                                                                                                 

 

                                                                                                                                 

 

                                                                                                                                 

Hat                         Coat                                 Associates:

                                                                                                                                 

Cap                        Jacket

                                                                                                                                 

Blouse                              Dress

                                                                                                                                 

Shirt                       Sweater

                                                                                                                                 

Skirt                       Trousers