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Instructions for Applying for a Peddlers and Itinerant Merchants License 1. You must read, understand and comply with all provisions of Chapter 66, Article III – Peddlers and Itinerant Merchants of the Morgan County Code of Ordinances. 2. You must get fingerprinting done at the Sherriff’s office, located at 1380 Monticello Highway, Madison, Georgia 30650. To do this you must call (706) 342-1507 to make an appointment. All appointments must be made seven days in advance. a. $5.00 At the time fingerprinting is done you will need to bring the following: cash only b. $37.25 for County printing fee. money order only payable to Morgan County Sheriff’s Office 3. You must complete and sign an Individual Criminal History Consent Form at the Sheriff’s office. for processing fingerprints. 4. Please complete the Peddlers and Itinerant Merchants License Application. The Georgia Security and Immigration Compliance Act Benefit Affidavit must be signed and notarized. Incomplete applications will not be accepted. 5. When submitting your application and forms, we will also require a copy of your driver’s license or any other form of photo identification listed on the attached Affidavit. Return the application and forms in person to the Morgan County Planning and Development Office after completing the fingerprints and background check. 6. The license fee is $100.00 and is payable to Morgan County in the form of cash or check only. The license is only valid for one individual, and will expire on December 31st of the year the license was issued. MORGAN COUNTY PLANNING AND DEVELOPMENT 150 East Washington Street, Suite 200 P.O. Box 1357 Madison, Georgia 30650 (706)342-4373 Office · (706)343-6455 Fax ---PAGE BREAK--- 1. APPLICANT NAME: 2. APPLICANT MAILING ADDRESS: 3. APPLICANT PHYSICAL ADDRESS: 4. E-MAIL ADDRESS: 5. TELEPHONE 6. DESIRED PLACE OF BUSINESS: 7. PLACE(S) OF BUSINESS FOR PREVIOUS 6 MONTHS: MUST GIVE PHYSICAL AND MAILING ADDRESS, IF DIFFERENT. MOST RECENT LOCATION: ADDRESS: CITY, STATE, ZIP: DATES OF SALE: NATURE OF BUSINESS: ADDITIONAL LOCATION: ADDRESS: CITY, STATE, ZIP: DATES OF SALE: NATURE OF BUSINESS: ADDITIONAL LOCATION: ADDRESS: CITY, STATE, ZIP: DATES OF SALE: NATURE OF BUSINESS: MORGAN COUNTY PLANNING AND DEVELOPMENT Post Office Box 1357 150 East Washington Street, Suite 200 Madison, Georgia 30650 (706) 342-4373 Office (706) 343-6455 Fax Return application & notarized affidavit Morgan County Planning and Development 150 E. Washington Street, Suite 200, Madison, Georgia 30650 OFFICE USE ONLY Zoning License # Tax Map and Parcel Amount Paid $ Payment type Issued by: Date NAICS CODE Peddlers and Itinerant Merchants License Application 13. I certify that the all information given is true and correct to the best of my knowledge, and that I have read, understand and will comply with all provisions of Chapter 66, Article III—Peddlers and Itinerant Merchants of the Morgan County Code. I understand that the issuance of a Peddlers and Itinerant Merchant license does not indicate conformity with Morgan County Ordinances and it is my responsibility to conform with all ordinances. Morgan County expressly reserves the right to enforce any and all ordinances, regardless of payment. Signature Title Date • COMPLETE APPLICATION MUST BE RETURNED IN PERSON. INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. • PHOTO ID PROVIDED MUST MATCH APPLICANT NAME. • PAYMENT AND AFFIDAVIT MUST ACCOMPANYAPPLICATION. MAKE CHECK PAYABLE TO: MORGAN COUNTY Thank you for doing business in Morgan County! 8. STATEMENT OF GOODS DESCRIBE TYPE AND QUALITY OF GOODS: INVOICE VALUE FOR GOODS: COUNTRY OF MANUFACTURE: LOCATION OF GOODS: 9. ADVERTISEMENT WHAT TYPE OF ADVERTISEMENT HAS BEEN DONE FOR THE BUSINESS? (Copies of any advertisement must accompany this application.) 10. FEDERAL TAX I.D. OR SOCIAL SECURITY#: 11. STATE SALES TAX # (IF APPLICABLE): 12. STATE USE TAX # (IF APPLICABLE): ---PAGE BREAK--- Georgia Security and Immigration Compliance Act Applicant Benefit Affidavit Applicant: Name of Establishment: Establishment Address: By executing this affidavit under oath, as an applicant for an Peddlers and Itinerant Merchants License, as referenced in O.C.G.A. § 50-36-1, from the Morgan County Board of Commissioners, the undersigned applicant verifies one of the following with respect to my application for a public benefit: I am a United States citizen. I am a legal permanent resident of the United States. I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 50-36-1(e)(1), with this affidavit. In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute. This document was executed in Madison, Georgia. Signature of Applicant Printed Name of Applicant SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF NOTARY PUBLIC My Commission Expires: Official Use Only The secure and verifiable document provided with this affidavit can best be classified as: U.S. Passport U.S. Passport Card U.S Military ID U.S Driver’s License* Tribal ID Card U.S. Permanent Resident Card Alien Registration Card Foreign Gov. Passport Employment Authorization Card Merchant Mariner Card Free & Secure Trade Card Nexus Card SENTRI Card Canadian Driver’s License Certificate of Citizenship Certificate of Naturalization Matricula Consular ID Copy of Document Attached *Note: A driver’s license from Alaska, Idaho, Illinois, New Jersey, New Mexico, New York, Rhode Island, Utah and Washington is not a verifiable document. Maryland and Massachusetts are pending. Verified By: Date: