<p> TOWN OF MANCHESTER APPLICATION FOR VENDOR – SOLICITOR – PEDDLER LICENSE</p><p>DATE: ______FEE: Resident $50.00 FEE: Non-Resident $100.00 Military Veteran Y or N</p><p>GENERAL INFORMATION</p><p>Applicant Name (print) ______Home Address ______City______State ______Zip______Telephone (H) ______(W) ______(C) ______Date of Birth Social Security Number Driver’s License # State/Expiration Date Name of Employer or Business Name ______Business Address ______Describe the nature of the business or the goods to be sold: ______</p><p>______Please provide the following for all vehicles to be used:</p><p>1. Make ______Model ______Year ______Color ______Reg. # ______2. Make ______Model ______Year ______Color ______Reg. # ______Please review the attached “Rules and Regulations” for vending before proceeding.</p><p>Item #1: Are you selling door to door?</p><p>Yes Proceed to Item #4.</p><p>No Proceed to Item #2.</p><p>Item #2: Are you selling from private property? Location address: Yes Contact the Zoning Officer located ______at the Building Dept., 494 Main Street, Zoning Official Signature 2nd Floor, for location approval. Upon completion, proceed to Item #4. ______Printed Name of Official Date No Proceed to Item #3.</p><p>Item #3: Are you selling from public property at a specific location? R 6-11-2013 1 MPD 147 Requested location address: </p><p>Yes Obtain a plot plan identifying your ______vending location from the Town Manchester Police Signature Engineering Department, Maps and Records, 494 Main Street, 2nd Floor. ______Submit the plot plan to the Manchester Printed Name of Official Date Police Department, Records Division, 239 East Middle Turnpike for traffic ______proceed to Item #4. Approved Location</p><p>No Proceed to Item #4.</p><p>Item #4: Are you selling food?</p><p>Yes Contact the Town Health Department ______located at 479 Main Street, 2nd Floor, Health Department Official Signature telephone (860) 647-3173, for application or download application at www.manchesterct.org. Upon completion, proceed to “Acknowledgements”. ______Printed Name of Official Date</p><p>No Proceed to “Acknowledgements”.</p><p>Acknowledgements I hereby acknowledge that I have received a copy of the Rules and Regulations for Peddling and Soliciting.</p><p>I hereby authorize and acknowledge that a criminal records check may be conducted by the Manchester Chief of Police or his designee.</p><p>Signature of applicant: ______Date: ______</p><p>To obtain Vendors License submit this completed application to: Manchester Police Records Division located at 239 Middle Turnpike East Office use only Copy of Driver’s License Copy of Veteran Form DD 214 Criminal Record Check </p><p>Fee Paid $ on .</p><p>Approved ____ Denied ____ Signature ______Date______</p><p>Notification sent to: Board of Health Manchester Fire Department. 8th District Fire Department</p><p>R 6-11-2013 2 MPD 147</p>