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Vendor License Renewal – Updated 11/08/24 Page 1 of 2 CITY OF MOSCOW VENDOR LICENSE – RENEWAL APPLICATION APPLICATION FEE: ☐ Fingerprints done within 5 years ($36.00) ☐ Fingerprints needed ($62.00) Name: LAST FIRST MIDDLE (MAIDEN) Local Address: STREET CITY STATE ZIP Cell or Local Phone Email: Business Name or Employer Name: Business Address: STREET CITY STATE ZIP Business Phone Fax Number: Tax ID#: Date Original License Granted: Briefly describe the nature of business and goods to be sold or services to be performed: Have you ever, anywhere or at any time been convicted of any crime, both misdemeanors and felonies, or violated any City of Moscow ordinance? [ ] YES [ ] NO If you answered “YES” above, please state the following for each offense: DATE OF OFFENSE NATURE OF OFFENSE PENALTY ASSESSED Have you ever, anywhere or at any time, been found guilty of, plead guilty to, received a withheld judgment, or admitted to the elements of any crime or substantially similar provision of foreign criminal violation listed in Moscow City Code Section 9- 11-9 or acknowledge there is sufficient evidence where a judge or jury could find you committed any of the offenses listed in Moscow City Code Section 9-11-9 beyond a reasonable doubt? [ ] YES [ ] NO If you answered “YES” above, please state the following for each offense: DATE OF OFFENSE NATURE OF OFFENSE PENALTY ASSESSED (Continued to the next page) ---PAGE BREAK--- Vendor License Renewal – Updated 11/08/24 Page 2 of 2 THE CITY OF MOSCOW REQUIRES: 1. A processing fee with this Application (see fees above). Fee is nonrefundable. 2. A valid Driver’s License or other valid government issued identification to be shown and copied. 3. Photograph taken within the last sixty days of the date of this application (approximately two inches by two inches that shows head and shoulders in a clear and distinguishing manner). I, the undersigned applicant, certify that if a vendor license is granted to me, it will not be used or represented as an endorsement by the City of Moscow for vending operations approved by said vendor license. I also declare that I have read all of the above, and certify under penalty of perjury pursuant to the law of the State of Idaho that each and every statement made is true, correct and complete. REQUIREMENT: SIGN IN FRONT OF A MOSCOW POLICE DEPARTMENT DEPUTY CITY CLERK Applicant’s Signature Date ATTEST: Clerk/Deputy Signature Date