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City of Gilbert 105 S.E. Second Street P.O. Box 29 Gilbert, IA 50105 (515) 233-2670 APPLICATION FEE $2.00 per applicant LICENSE FEE $10.00 for one day or any part thereof $20.00 per day for up to one week $40.00 per week for up to 6 months $50.00 for 1 year or major part thereof BOND REQUIREMENT: Evidence that applicant has filed a bond with the Secretary of State. Name of Applicant: Social Security Permanent Address: Permanent Phone Local Address: Local Phone Business Address: Business Phone Applicant’s Employer: Employer Address: Employer Phone Nature of Employer’s Business: Communities in which Applicant/Applicant’s Business has solicited within the past two years: Length of time sought to be covered by license: Beginning Date: Ending Date: (Licenses are in force and effect only between the hours of 8:00 a.m. and 6:00 p.m.) PHYSICAL DESCRIPTION OF APPLICANT (including recent photograph): Date of Birth: Hair Color: Height: Eye Color: Weight: Have you ever been convicted of a felony, or crime of theft or fraud? □ Yes □ No If “yes,” give full details: Applicant shall provide a copy of a current Department of Criminal Investigations (DCI) background check, or shall make payment to the City of Gilbert for the costs associated with conducting a DCI background check. I hereby certify that the statements made herein are true and correct as I verily believe. Applicant’s Signature FOR OFFICE USE ONLY: Date of Approval: License Signature of City Clerk: