Lansing, MI

Application for License to Sell Ice Cream Products or Confections

Steps

1. Step One This section is complete This section is incomplete
2. Step Two This section is complete This section is incomplete
3. Step Three This section is complete This section is incomplete
4. Step Four This section is complete This section is incomplete
5. Step Five This section is complete This section is incomplete

Step One

Contact us
If you desire assistance or have questions about this form, you can email us at [email protected], call us at (517) 483-4133, or visit us in the City Clerk's office, located on the 9th floor of City Hall (124 W Michigan Avenue, Lansing, MI 48933).
Instructions
Complete and print this form. DO NOT sign this form unless you are with a notary public. This form can be notarized at the City Clerk's office. Bring this printed form and the materials listed below to the City Clerk's office to complete the application process.
Materials
(1) Photo, (2) completed Criminal History Conviction Record Check Authorization Form for each employee, (3) the list of employees and vehicles, (4) fee payment, and (5) a copy of your insurance policy.
Photo Identification
The applicant must supply a photograph of him or herself, taken within 60 days immediately prior to the date of the filing of the application. The pictures must be two inches by two inches, showing the head and shoulders of the applicant in a clear and distinguishing manner. Pictures can be taken at the City Clerk's office for an additional fee, or emailed to tracy.scott@lansingmi.gov with the subject line "[your full name] APPLICATION PHOTO".
The applicant must supply a photograph of him or herself, taken within 60 days immediately prior to the date of the filing of the application. The pictures must be two inches by two inches, showing the head and shoulders of the applicant in a clear and distinguishing manner. Pictures can be taken at the City Clerk's office for an additional fee, or emailed to [email protected] with the subject line "[your full name] APPLICATION PHOTO".
Criminal History Conviction Record Check Authorization Form
Link
Each employee must fill out and print a copy of this form. Bring one completed form for each employee with you to the City Clerk's office to complete the application process.
List of Employees and Vehicles
Link
Please fill in this form then print it out. Bring it with you to the City Clerk's office to complete the application process.
Fees
$15 per Vehicle for 6 Month License; $25 per Vehicle for 12 Month License. $25 per Agent / Employee of the company for background check as per LCO 844.22
Length of time for which the right to do business is desired*
1. 6 months
2. 12 months
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Step Two

Applicant's First Name*
Last Name*
Applicant's Phone Number*
Applicant's Mailing Address
Street Address*
City*
State*
Zip Code*
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Step Three

Business Name*
Business Phone Number*
Owner's First Name*
Owner's Last Name*
Business Physical Address
Street Address*
City*
State*
Zip code*
Business Mailing Address
Street Address*
City*
State*
Zip code*
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Step Four

Goods to be sold are:*
Michigan Sales Tax License No. *
Insured By*
Print insurance policy and present it with application.
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Step Five

By signing, I the applicant, certify that I have sent, or will send, each and every person to be employed, current and future, under this license for a police background check, as required under City Code 844.22(b). I certify that nothing, other than ice cream, ice cream products or confections, will be vended and sold under the terms of such license. I understand that ANY violation of the City Code may result in the immediate revocation of this license.
By signing, I the applicant, certify that I have sent, or will send, each and every person to be employed, current and future, under this license for a police background check, as required under City Code 844.22(b). I certify that nothing, other than ice cream, ice cream products or confections, will be vended and sold under the terms of such license. I understand that ANY violation of the City Code may result in the immediate revocation of this license.
Applicant's Signature (DO NOT sign except in the presence of a notary)
___________________________________________________________________
Date
________________
Subscribed and sworn to before me this ________ day of ____________________, 20_______, acting in the County of ____________________, Michigan.
Notary Signature
___________________________________________________________________
Date
________________
Print Notary's Name
___________________________________________________________________
Commission Expires
________________
Approved by Police Department
Date
Date
Amount paid
Date paid
Date paid
License number

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1. Receive an email copy of this form.
Email address

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Application for License to Sell Ice Cream Products or Confections

Steps

Step One

Contact us

Instructions

Materials

Photo Identification

Criminal History Conviction Record Check Authorization Form

List of Employees and Vehicles

Fees

Step Two

Applicant's Mailing Address

Step Three

Business Physical Address

Business Mailing Address

Step Four

Step Five

Applicant's Signature (DO NOT sign except in the presence of a notary)

Date

Notary Signature

Date

Print Notary's Name

Commission Expires

Contact

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