Type Full Name :
Sign With Hand
Email
Telephone #
If Yes, please provide the date
Date of Event *
Have you ever been convicted of a crime?
State *
Race *
Certification*
Fee Schedule
State
140 North Broadway
Type of Business *
First Name
Do you have a Veteran's License?
Last Name *
Applicant History
By signing below, I hereby acknowledge that the information contained in this application is truthful and accurate.
Driver License # *
Date of Birth *
Have you ever been arrested?
Owner Details
140 North Broadway
www.southamboynj.gov
Telephone # *
South Amboy, NJ 08879
(732) 727-4600
Sex
* Indicates required field
I acknowledge that the application I am making requires me to consent to a criminal background check as a condition of approval. This check includes the following: Criminal history reference searches for felony and misdemeanor convictions at the county and federal levels of every jurisdiction where I currently reside or where I have resided during the past 7 years; and sex offender registry searches at the county and federal levels in every jurisdiction where I currently reside or where I have resided.
Peddlers License
City of South Amboy
Address *
Amount Due
Attachments
South Amboy, NJ 08879
City of South Amboy
Zip
If yes, please provide the date
By signing below I hereby authorize the release of any information maintained by your agency, meeting dissemination criteria for the purpose of peddling in the City of South Amboy, to the South Amboy Police Department. I understand the any such information released as a result of this authorization shall be used only for the express purpose as indicated.
First Name *
A copy of your driver's license can be attached to this application in the window below. Click the Select Files button, select the file(s) to be attached, and click Open.
Address
Zip *
E-mail *
Social Security # *
Last Name
Previous Address*
City *
City
Checks are to be made payable to: "City of South Amboy". Please mention Peddlers License in the memo area.
Applicant Details