County Registrar
LICENSE NO ________
FOR PEDDLER/SOLICITOR IN UNINCORPORATED ST. CHARLES COUNTY,
ISSUED PURSUANT TO CHAPTER 606, OSCCMO
Information Required by Section 606.165.A, OSCCMo
The Chief of Police and Registrar of St. Charles County acknowledge receipt of the costs of
processing this application for license no ________ for peddler/solicitor in unincorporated St.
Charles County – including the non-refundable application fee and the fee for the applicant’s
photo identification badge – and hereby issue this License No _______ to the licensee and for the
purposes and period described below:
1. Name of licensee: ____________________________________________________________
2. Permanent home address of licensee: _____________________________________________
______________________________________________________________________________
3. Name and address of individuals, firm, corporation, organization, association or group
represented by licensee, if other than self:
__________________________________________
______________________________________________________________________________
4. Nature of merchandise to be sold or offered for sale, the nature of the services to be furnished,
or purpose for peddling/soliciting: __________________________________________________
______________________________________________________________________________
5. First day of (4) (7) (strike one) period for which this license is valid: ____________________
6. Last day of (4) (7) (strike one) period for which this license is valid: ____________________
7. The make, model, year, color and license number and State of licensing of the applicant's
motor vehicle: _________________________________________________________________
ST. CHARLES COUNTY REGISTRAR
____________________________________
Name (date)
(Seal)
ST. CHARLES COUNTY CHIEF OF
POLICE
____________________________________
Col. David L. Todd (date)
201 N. Second St. – Suite 541 I St. Charles, MO 63301 I P 636.949.7560 I 1.800.822.4012 I F 636.949.7562 I [email protected] I www.sccmo.org
8. Place or places of residence of the applicant for the preceding three (3) years: _____________
______________________________________________________________________________
______________________________________________________________________________
9. Names of other communities in Missouri in which the applicant has worked as a
peddler/solicitor in the past two (2) years: ____________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(Attach additional sheet if necessary)
10. Name of other communities in Missouri in which the individual, firm, corporation,
organization, association or group for which applicant is peddling/soliciting has engaged in
peddling/soliciting in the past two (2) years: __________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
(Attach additional sheet if necessary)
11. Whether or not the applicant has ever been convicted of a violation of a felony under laws of
the State of Missouri, or any other state or federal law of the United States. _________________
12. Name(s) of the individual, firm, corporation, organization, association or group for which
the applicant will be peddling/soliciting: _____________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________
(Attach letter or written statement from each individual, firm, corporation, organization,
association or group, named above, certifying that the applicant is authorized to act as
representative of that individual, firm, corporation, organization, association or group.)
13. Applicant agrees upon request submit to fingerprinting and photographing by the Police
Department in connection with the application for the license: ___ (yes) ___ (no) (check one)
14. Applicant understands that when more than one (1) individual plans to peddle/solicit for the
same corporation, organization, association or group, each such individual must fill out an
application and each such individual shall pay the filing fee set out in the approved fee schedule:
___ (yes) ___ (no) (check one)
15. Applicant understands that all statements made by the applicant upon the application or in
connection therewith shall be under oath: ___ (yes) ___ (no) (check one)
16. Applicant's State sales and use tax number as required by Chapter 144, RSMo: ___________
______________________________________________________________________________
I SWEAR OR AFFIRM THAT THE ABOVE STATEMENTS ARE TRUE, ACCURATE AND
COMPLETE:
____________________________________
(Signature of Applicant)
Given under my hand and official seal this _______ day of _____________________20__.
_______________________________
County Registrar
PAYMENT OF FILING FEE
(FOR REGISTRAR’S USE ONLY)
Applications are not complete unless accompanied by non-refundable filing fee per fee schedule
approved by the Director of Administration pursuant to Sections 606.160 and 606.165.A,
OSCCMo
Non-refundable filing fee of $____.___, paid this ___ day of _________, 20___.
_______________________________
County Registrar
ENDORSEMENTS AND APPROVAL OR DENIAL BY POLICE CHIEF
(FOR POLICE USE ONLY)
Considerations Under Section 606.165.C, OSCCMo
Within two (2) years of the date of this application, has the
individual requesting this license:
Yes or No?
___________________
(1) Been convicted of the commission of a felony under
the laws of Missouri or any other State or Federal law of
the United States?
___________________
(2) Been convicted of a violation of any of the provisions
of this Chapter?
___________________
(3) Lost his/her license by revocation as herein provided?
___________________
(4) Been convicted of a crime, misdemeanor or violation
of any ordinance concerning canvassing or
peddling/soliciting?
___________________
(5) Falsified any information required by this Chapter as a
part of the application process?
___________________
(6) Is a registered sex offender in any jurisdiction?
___________________
If the answer to any question is “yes”, Police Chief shall attach documentation supporting that
answer, and refuse to approve this application:
Approved:
____________________________________________________________
Col. David L. Todd, Chief of Police, St. Charles County
(Date)
Refused:
____________________________________________________________
Col. David L. Todd, Chief of Police, St. Charles County
(Date)