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Office of the City Clerk Room 202 City Hall Albany, New York 12207 Phone: [PHONE REDACTED] Fax: [PHONE REDACTED] Kathy Sheehan Danielle Gillespie Mayor City Clerk Application for General License The following questions must be completed in full, and the affidavit below properly executed and signed by the applicant. If applicant is a firm or corporation, the person filing on its behalf must be an officer of the company and official title must accompany the signature. Failure to comply will result in the application not being processed. Second Hand Dealer $210.00 Collateral Loan Junk Dealer $150.00 1. Name of Applicant (If corporation, state names of officer Home Address City State Zip Code Phone Number Fax number * Business Address City State Zip Code Phone Number Fax number Date of Birth Place of Birth Sex Weight Height Eye Color Social Security # - - 1. Length of time applicant has resided in City of Albany 2. Address where business is to be carried on ---PAGE BREAK--- 3. Previous Employment: Employer Employer Employer 4. Have you ever convicted of a crime or misdemeanor? Yes No If so, state where, when, and nature of: 5. Has any license been revoked or denied by the City of Albany or elsewhere in the last State grounds for 6. Have you had, either alone or with someone else, previously been a Second Hand Dealer, Collateral Loan Broker or Junk Location: How long were you 7. Have you been known by any other name other than the one given on this Official State of New York, County of Albany, City of Albany. being duly sworn, deposes and says that he/she is the person signing the forgoing application and that the answers above are true in all respects and particulars. Sworn to before day Notary Public, Commissioner of Deeds, Albany, NY ---PAGE BREAK--- Premises (not) Chief of Police Premises (not) Chief of Fire Department Action by City Clerk Application (approved) (Denied) and license (issued) (not issued) License