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NO COMMERCIAL SOLICITATION LIST - REGISTRATION FORM Prohibits ONLY commercial solicitors from door-to-door solicitation at property listed below, NOT non- profit or religious door-to-door solicitors City of Douglas [PHONE REDACTED]-phone P.O. Box 1030, 101 N. 4th Street [PHONE REDACTED]-fax Douglas, WY 82633 www.cityofdouglas.org Full Name: Physical Address: City/State/ZIP Mailing Address: City/State/ZIP Telephone Number: Email address: By signing below, I am certifying that I am the owner or lawful occupant of the above listed property. Per Section 5.20 of the Douglas Municipal Code, I understand that this list will be maintained by the City of Douglas and will remain on the list for a period of five years and will then be deleted unless I submit a new form to keep my name active on this list. I understand that my name and address will be published on the City of Douglas website. Any person shall by operation of the inclusion on this list shall indemnify and hold the City, its employees, agents and representatives, including members of the City Council in their representative capacities, harmless from any liability, loss or damage which may be incurred as a result of claims, demands, costs, or judgments arising out of, connected with, or concerning the issuance, use or existence of this list. Signature Date ATTEST: City Clerk Date • This form must be renewed before the day of in order to maintain a listing on the no commercial solicitation list.