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<br /> <br />ervi{{e <br />'Esta6{isfietf 1857 <br />~/~A4.1 a,JJ~a <br /> <br />FEE: <br /> <br />PAID: <br /> <br />RECEIPT #: <br /> <br />TRANSIENT MERCHANT, PEDDLER INFORMATION/APPLICATION <br />SHEET <br /> <br />In an effort to provide the public of the City ofCenterville with the best quality of life within its <br />corporate City Limits, the City has determined that the following information be received from <br />any and all persons or firms wishing to conduct door-to-door sales and/or setting up a temporary <br />sales site: <br /> <br />] . Name and description of applicant: (If more than one person, attach the following <br />information on a separate sheet) <br /> <br />Name: Ly h~ <br />(First) <br /> <br />Eyes: -E I iI~ <br /> <br />Weight & Build: ~ <br /> <br />- <br />(Middle) <br />Hair: 13 r(j(1 ~ <br /> <br />il:;~",-~I'> ~ <br />(Last) <br /> <br />Height: ~ <br /> <br />Date of Birth: ~ <br /> <br />Drivers License #: <br /> <br /> <br />(Include a copy of Driver's License) <br /> <br />2. <br /> <br />Permanent Home Address: <br /> <br />1. <br /> <br />72'0 O'l./'fY <br />( <br />Cc",,+c>" V It <br /> <br />-1-<<. <br /> <br />AUT: <br /> <br />Dates of Occupancy: <br /> <br /> <br />550 J gr <br /> <br /> <br />Telephone Number: <br /> <br />C '5/ l.!")0 /00'1 <br /> <br />2 <br />