TOWN OF QUARTZSITE VENDOR LICENSE

ANY PERSON OPERATING AS A VENDOR IN THE TOWN OF QUARTZSITE SHALL REGISTER WITH THE TOWN AND OBTAIN A VENDOR LICENSE. SAID LICENSE DOES NOT TAKE THE PLACE OF ANY PERMIT OR LICENSE REQUIRED BY THE STATE OF ARIZONA . THIS LICENSE IS NON-TRANSFERABLE FROM SELLER TO SELLER. LICENSE MUST BE POSTED & VISIBLE FROM A DISTANCE OF TWENTY +(20) FEET.

DBA:_______________________________________________________________________________

NAME:______________________________________________________PHONE:_________________

PERMANENT ADDRESS:_______________________________________________________________

DESCRIPTION OF BUSINESS/MERCHANDISE:____________________________________________

LA PAZ COUNTY HEALTH PERMIT #:_______________ AZ RESALE TAX #:_____________________

BUSINESS LOCATION & SPACE #:_______________________________________________________

VALIDATED BY:______________________________PAYMENT-____CASH ____CHECK #________

DATE:__________________ APPLICANT SIGNATURE *:___________________________________

REFUSAL TO COMPLY SHALL RESULT IN EITHER A CRIMINAL OR CIVIL CITATION FOR VIOLATION OF THIS CHAPTER. IF FOUND RESPONSIBLE, A PENALTY SHALL BE A FINE OF $250.00 FOR THE FIRST OFFENSE. IF FOUND RESPONSIBLE FOR A SECOND OFFENSE A FINE OF AT LEAST $250.00 & INELIGIBILITY TO OBTAIN A FUTURE VENDOR SALES PERMIT FOR FIVE (5) YEARS. EACH DAY A VIOLATION CONTINUES SHALL BE A SEPARATE OFFENSE PUNISHABLE AS HEREIN ABOVE DESCRIBED.

*I CERTIFY THE FACTS TO BE TRUE AND CORRECT IN ACCORDANCE WITH A.R.S. §13-2704(A)

THIS AREA IS FOR TOWN USE ONLY.

APPLICATION SENT OUT BY Web Application DATE

APPLICATION RECORDED IN BY DATE

RETURN APPLICATION TO:

TOWN OF QUARTZSITE

PO BOX 2812

QUARTZSITE, AZ 85346-2812

ATTN: Leanna W.