10.06 - Pawnbroker License - Laserfiche WebLink

Home Browse Search

design of the proposed premises to be licensed. 13. The name, address and nature of the interest held by any person or entity other than the applicant in the premises or business proposed to be licensed. Name: Address: Nature of interest: 14. Are any taxes, special assessments, utility charges or any other monies delinquent or owed to the City or any other governmental agency of the State by the applicant or organization on behalf of which application is being made? Yes If yes, give details: No 15. License Fee - $150.00 per year 16. Investigative fee(Non-Refundable) - $50.00 (new license) - $25 (renew license) 17. Bond- $5,000.00 (made payable to the City of Pequot Lakes and running for the license year). 18. Certificate of Insurance showing proof of worker's compensation coverage (Minnesota Statute 176.182) Make check or money order payable to the CITY OF PEQUOT LAKES and return to the OFFICE OF THE CITY CLERK, 4638 COUNTY ROAD 11, PEQUOT LAKES,MN 56472. I hereby certify that the information provided herein is true and correct to the best of my knowledge and belief, and that the City Council of the City of Pequot Lakes may rely on the accuracy of such information provided in determining whether or not a license should be issued. (Signature of Applicant) Subscribed and sworn to before me this day of , (Notary Public) (notary seal)