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00 Fire Inspection Fee 84. 00 APPLICATION FOR DEALER IN SALVAGE OR SCRAP METAL LICENSE Name of Applicant Phone Number Address Applicant Business Name Zip Code Phone Number Address of Business Zip Code Email Address Age of Applicant Length of time this business has been in Indianapolis Name of person responsible for the operations at this location Legal Status of Business Individual Proprietor Partnership Corporation LLC If Corporation or LLC list state where incorporated or authorized Registered Agent s name Has the applicant or any partner or corporate officer for the applicant business ever been denied a license or had a license revoked or suspended Yes No a felony misdemeanor or ordinance violation other than a minor traffic charge Yes No If yes list type of conviction and jurisdiction NOTE A certified copy of a statement from the Secretary of State of the state of Indiana that the corporation is registered in the state of Indiana and is duly qualified to do business in the state of Indiana must be attached to this application. Please indicate that you agree or disagree by marking yes or no for the following Licensee is in good standing and has not had any license or registration to operate a business revoked or suspended Yes No Licensee is current with all City County and State for any taxes license fees or any other indebtedness Yes No The person signing this application has the authority to sign for the business being licensed Yes No Licensee will permit inspections of the business and premises by public authorities acting pursuant to law Yes No Licensee will conduct the business and premises in such a manner as not to create a nuisance or any sort of hazard to the public Yes No material Yes No Licensee agrees that the business and the premises on which the business is conducted will not be used for any unlawful purpose Yes No applicable laws ordinances regulations orders and decisions of public officials Licensee understands that the license may be suspended or revoked and the licensee will be subject to prosecution if any applicable law ordinance regulation order or decision is violated location of the business if permitted by ordinance Yes No to exist the licensed business during the term of the license such that the information provided in the application form is no longer complete or accurate within 30 days after such change occurs Yes No By signing below the licensee agrees that in the event the applicant as licensee receives personal propertv of any kind which is stolen s/he claims no right title or interest in or to such personal property and that upon request by any law enforcement officer having jurisdiction over the location of the place of business s/he will voluntarily surrender such personal property to the possession of that law enforcement agency when given a receipt for the same. Licensee also agrees to keep and preserve a legible record in a written or electronic form approved by the controller of all purchase transactions to which the salvage or scrap metal dealer is a party. The undersigned affirms under penalty for perjury that the answers representations and information provided Signature Name Printed Date Signed. Indianapolis Department of Code Enforcement 1200 Madison Avenue Suite 100 Indianapolis IN 46225 Phone 317 327-4316 Fax 317 327-0817 New Renewal License 568. 00 Fire Inspection Fee 84. 00 APPLICATION FOR DEALER IN SALVAGE OR SCRAP METAL LICENSE Name of Applicant Phone Number Address Applicant Business Name Zip Code Phone Number Address of Business Zip Code Email Address Age of Applicant Length of time this business has been in Indianapolis Name of person responsible for the operations at this location Legal Status of Business Individual Proprietor Partnership Corporation LLC If Corporation or LLC list state where incorporated or authorized Registered Agent s name Has the applicant or any partner or corporate officer for the applicant business ever been denied a license or had a license revoked or suspended Yes No a felony misdemeanor or ordinance violation other than a minor traffic charge Yes No If yes list type of conviction and jurisdiction NOTE A certified copy of a statement from the Secretary of State of the state of Indiana that the corporation is registered in the state of Indiana and is duly qualified to do business in the state of Indiana must be attached to this application. Please indicate that you agree or disagree by marking yes or no for the following Licensee is in good standing and has not had any license or registration to operate a business revoked or suspended Yes No Licensee is current with all City County and State for any taxes license fees or any other indebtedness Yes No The person signing this application has the authority to sign for the business being licensed Yes No Licensee will permit inspections of the business and premises by public authorities acting pursuant to law Yes No Licensee will conduct the business and premises in such a manner as not to create a nuisance or any sort of hazard to the public Yes No material Yes No Licensee agrees that the business and the premises on which the business is conducted will not be used for any unlawful purpose Yes No applicable laws ordinances regulations orders and decisions of public officials Licensee understands that the license may be suspended or revoked and the licensee will be subject to prosecution if any applicable law ordinance regulation order or decision is violated location of the business if permitted by ordinance Yes No to exist the licensed business during the term of the license such that the information provided in the application form is no longer complete or accurate within 30 days after such change occurs Yes No By signing below the licensee agrees that in the event the applicant as licensee receives personal propertv of any kind which is stolen s/he claims no right title or interest in or to such personal property and that upon request by any law enforcement officer having jurisdiction over the location of the place of business s/he will voluntarily surrender such personal property to the possession of that law enforcement agency when given a receipt for the same. Licensee also agrees to keep and preserve a legible record in a written or electronic form approved by the controller of all purchase transactions to which the salvage or scrap metal dealer is a party.

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