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<br />~ <br /> <br />ervi{{e <br />'Est4fiisfid 11I57 <br /> <br />FEE: ,1",..,;;1 -.is Jt.'1 a)U'-'oy.,p <br /> <br />PAID: <br /> <br />RECEIPT #: <br /> <br />TRANSIENT MERCHANT, PEDDLER INFORMATION/APPLICATION <br />SHEET <br /> <br />" <br /> <br />In an effort to provide the public of the City of Centerville 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 />1. <br /> <br />Name and description of applicant: }If more than one person, attach the following <br />information on a separate sheet) (?v->1""iTi2-.Il....L.l! L-Ib,->$ LL-v"!3-) <br />r <br />Name: (~b6>L1 L.::>Av 9 I/' I"~/~'- <br />(First) (Middle) (Last) <br /> <br />Eyes: <br /> <br />i3v....J <br /> <br />Hair: <br /> <br />~ <br /> <br />Height: <br /> <br />~I I{ <br />'-;7 II <br /> <br />Weight & Build: <br /> <br />I hZ--- <br /> <br />Date of Birth: "3> ~ 17-b.? <br /> <br />Drivers License #: W 9:Z- 3:2-- I g44 '9'914- <br />(Include a copy of Driver's License) <br /> <br />2. <br /> <br />Permanent Home Address: 1. <br /> <br />'7 \ S-S 6;2..11'-1 i::>;:L'\hr <br /> <br />c::.-. rr- ..;;z.vWo-l! <br /> <br />-.} <br />, <br /> <br />97038 <br /> <br />Dates of Occupancy: <br /> <br />'7/ &>"7 <br />, <br /> <br />Telephone Number: <br /> <br />bO- - :Z--U -912-7 <br /> <br />2. <br /> <br />q <br />