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Fee Date / / VENDOR LICENSE - ICE CREAM TRUCK Please type or print clearly NAME of APPLICANT: HOME ADDRESS: BUSINESS ADDRESS: HOME PHONE: EMAIL: BUSINESS PHONE: DATE of BIRTH: PLACE of BIRTH: SOCIAL SECURITY NUMBER PROVIDE A LIST OF THE FROZEN PRODUCTS YOU WILL VEND DURING THE VENDING SEASON: ARE YOU SELF-EMPLOYED? IF NO, PLEASE GIVE THE NAME, ADDRESS AND PHONE NUMBER OF YOUR EMPLOYER: ARE YOU IN PARTNERSHIP WITH ANYONE ? IF YES, PLEASE GIVE THE NAME, ADDRESS AND PHONE NUMBER OF THE INDIVIDUAL OR CORPORATION: DO YOU HAVE CREDENTIALS AUTHORIZING YOU TO ACT AS REPRESENTATIVE OF ANOTHER? IF YES, ATTACH A SEPARATE PAPER DETAILING THE NATURE AND EXTENT OF THAT AUTHORITY AND THE NAME, ADDRESS AND PHONE NUMBER OF THE PERSON OR CORPORATION GIVING THE CREDENTIALS. ---PAGE BREAK--- DO YOU HAVE ANY FINANCIAL OR PROPRIETARY INTEREST IN ANY OTHER VENDING OPERATION WHICH IS ALSO APPLYING FOR A VENDING PERMIT FOR THE VENDING SEASON? IF YES: PLEASE ATTACH A SEPARATE PAPER DETAILING THAT INTEREST. HAVE YOU EVER BEEN KNOWN BY ANY NAME OTHER THAN THAT ON THIS APPLICATION: IF YES, WHAT? HAS A VENDORS LICENSE BEEN ISSUED, REVOKED or DENIED BY ANY MUNICIPALITY IN THE PAST FIVE YEARS? IF YES, EXPLAIN: HAVE YOU EVER BEEN CONVICTED OF A CRIME OR MISDEMEANOR? IF YES, INDICATE WHERE, DATE AND NATURE OF CRIME: HAVE YOU EVER BEEN FINGERPRINTED? IF YES, WHEN, WHERE AND BY WHAT AGENCY: I verify that all the answers and information given freely by me on this application are true and accurate in all aspects and particulars, and are made solely for the purpose of obtaining the issuance of a vendor's license to operate an ice cream truck. I understand that this allows only me to vend and I have no ability to transfer this license to anyone else. I understand that upon discovery, any inaccurate or misleading information may cause me to forfeit the permit. I hereby indemnify the City of Albany and hold it harmless for all loss, damage or injury to person or property as a result of any activities connected with the issuance and use of this license. In addition, I am knowledgeable concerning all Vehicle and Traffic Laws regarding frozen dessert trucks and vendors. Signature of Applicant Date SWORN BEFORE ME THIS DAY OF , 20 Commissioner of Deeds/Notary Public