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.COUNTY, GEORGIA

IN THE PROBATE COURT OF

APPLICATION FOR PEDDLER'S LICENSE

1. NAME: 2.

HOME ADDRESS:

3. PHONE: 4.

BUSINESS NAME:

5. BUSINESS ADDRESS: 6. BUSINESS PHONE: 7.

TEMPORARY ADDRESS:

S. DATE OF BIRTH:

CITIZEN OF GEORGIA?

9. TAG NUMBER: 10. DESCRIPTION OF EACH VEHICLE USED:

(A) (B)_ (Q_

0>)_

11. SOCIAL SECURITY NUMBER:. 12. DRIVER'S LICENSE NUMBER: 13. DATE OF ENTRY IN THE COUNTY:

14. DATE OF ESTIMATED COMPLETION:

STATE:


15. INDICATE NATURE OF BUSINESS TO BE SOLD USINGTHIS CERTIFICATE:

16. LIST NAMES OF EMPLOYEES:

17. NAME OF REFERENCE AND/OR OTHER COUNTIES YOU HAVE OPERATED IN:

OATH OF APPLICANT

I> •' , do solemnly swear under oath that the facts and statements made by me to the foregoing questions on this application are true and correct and that no false, misleading, or fraudulent statement is made therein. "I swear that I will use this license in no county other than the one for which it is granted and that I will not allow any other person to use it in my name, and that I am a citizen of the United States. So help me God."

Applicant's Signature

Sworn to and subscribed before methis the

day of

Judge of the Probate Court


STATE OF GEORGIA

COUNTY OF

PEDDLER'S LICENSE

As of

,

,

_, has been granted a PEDDLER'S LICENSE pursuant to O.C.G.A. ยง 43-32-1. This licenseis good from said date until THIS LICENSE IS ONLY GOOD IN THE COUNTY OF

this the

day of

,

. Issued

โ€ข

JUDGE OF PROBATE COURT


PEDDLERS LICENSE