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APPLICATION FOR VENDOR LICENSE PAGE 1 OF 2 CITY OF MOSCOW VENDOR LICENSE – NEW APPLICATION THE CITY OF MOSCOW REQUIRES: 1. A processing fee of sixty-two dollars ($62) with this Application which includes the background check and fingerprinting charges. 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 and show head and shoulders in a clear and distinguishing manner). Name LAST FIRST MIDDLE (MAIDEN) Permanent Address STREET CITY STATE ZIP Local Address: STREET CITY STATE ZIP Driver’s License/Govt’ ID: Social Security NUMBER STATE ISSUED Date of Birth: Place of Birth (City & State): Cell or Local Phone Tax ID Email: Business Name or Employer Name: Business Address STREET CITY STATE ZIP Business Phone Fax Number: Tax ID#: 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 (Continue to second page on the back of this sheet) ---PAGE BREAK--- APPLICATION FOR VENDOR LICENSE PAGE 2 OF 2 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 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 MCC 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 Fingerprints must be completed at the Moscow Police Department (155 Southview Ave). Call 883-7054 for hours of fingerprinting. 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 Updated 11/08/2024