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).
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.
(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.
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".
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.
Please fill in this form then print it out. Bring it with you to the City Clerk's office to complete the application process.
$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
Print insurance policy and present it with application.
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.
Subscribed and sworn to before me this ________ day of ____________________, 20_______, acting in the County of ____________________, Michigan.
This field is not part of the form submission.
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