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Carriage Owner Application2

Pedicab app

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bbecruisin
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14 views2 pages

Carriage Owner Application2

Pedicab app

Uploaded by

bbecruisin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

OFFICE USE ONLY LICENSE SECTION

LICENSE # CARRIAGE COMPANY


ISSUE DATE LICENSE
APPLICATION
EXPIRES

NEW RENEWAL

BUSINESS INFORMATION

Business Name: Federal ID:

Check One: Sole Proprietor Corporation Partnership LLC

Business Address:

City: State: Zip Code:

Phone Number: Cell Phone:

Email:

OWNER INFORMATION

Full Name:

Date of Birth: Email:

Current Address:

City: State: Zip Code:

Phone Number: Cell Phone:

Ohio Driver’s License Number: Expiration Date:

Sex: M F Race: Height: Weight: Hair: Eyes:

Are you legally authorized to work in the United States? YES NO

All applicants will be required to prove Lawful Presence in the United States and provide
Proof of Identity.

Have you had a City of Columbus license and/or permit revoked, suspended or refused within the last three (3) years?
YES NO If yes, please explain:

Have you ever been convicted of a felony? YES NO

List all felony convictions in the United States over the past seven (7) years. If none, write “NONE”.

Are you on felony probation or parole? YES NO If yes, date began:

Have you ever been required to register as a sexual offender? YES NO If yes, date began:

Page - 1 - of 2
List the name, date of birth, driver’s license number or State ID number, home address and title of all persons who
have a direct or indirect interest in the business (including partners, stockholders, lien holders and corporate officer):

1.
Name Date of Birth OL or State ID #

Title Home Address Zip Code

2.
Name Date of Birth OL or State ID #

Title Home Address Zip Code

Attached additional sheet(s) if necessary.

Number of Carriages to be licensed: Number of horses to be licensed:

Location of Stable:

Location of staging area:

Owner of Property:

Address:

Phone:

What rates will be charged:

List all criminal arrests and convictions within the past seven (7) years of any person having direct interest in
that which is to be licensed (If none write “NONE”):

ALL INFORMATION CONTAINED IN THIS APPLICATION IS SUBJECT TO DISCLOSURE AS A MATTER OF PUBLIC RECORD. ANY
FALSE STATEMENT MADE OR GIVEN IN THIS APPLICATION SHALL RESULT IN DENIAL OR FUTURE REVOCATION OF THIS
LICENSE, AS WELL AS CRIMINAL PROSECUTION UNDER CHAPTER 2321.13(A-3), (A-5) AND COLUMBUS CITY CODE 589.

State of Ohio, County of Franklin

, being duly sworn, deposes and says


( Print Applicant Name)

he/she is the individual making the foregoing application; that he/she is knowledgeable with respect to that which is
to be licensed; that the answers to the foregoing questions and other statements contained herein are true of his/her
own knowledge and belief.

Applicant Signature

Swore to before me and subscribed in my presence this day of , 20

Notary or Agent of Director of Building and Zoning Services


The application must be signed, dated, and notarized.

Page - 2 - of 2

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