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City of Salem LICENSE APPLICATION Ci ty Clerk’s Office 93 Washington Street, Room 3 Salem, MA 01970 NOTE: All licenses expire on December 31st of Current Year New License ⎕ License Renewal ⎕ CORI Required & Attached ⎕ TO THE CITY CLERK: The following applicant was interviewed by me Name of Applicant: Address of Applicant: For the following license (check applicable license): Junk Collector $50 Junk Dealer $100 Fee Paid $ Second Hand Clothing $50 Second Hand Valuable $100 Date Seaworms $10 Other: S/ Special Investigator TO THE CITY COUNCIL: The undersigned respectfully applies for the above license to operate in said City: Applicant’s Information (please print clearly and sign below): Name Date of Birth Street Address City, State, Zip Height Weight Phone No. Eye Color Hair Color Social Security No. Married Single Company Information (please print clearly): Name Business Phone No. Street Address City, State, Zip State Tax ID No. Signature of Applicant Any False Statement made on this Application is Grounds for Denial In City Ref. to Committee on Ordinances, Licenses & Legal Affairs In City GRANTED ---PAGE BREAK--- ---PAGE BREAK---