City Of Lexington Vendors License Application Form
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1City of Lexington Vendors License Application
Pursuant to Ordinance # 2300
Effective August 16, 2011
PLEASE PRINT
Applicant’s (owner) name ______________________________________________________________________
Business Name, if any _________________________________________________________________________
Permanent Address (not a PO Box) _______________________________________________________________
City / State / ZIP _____________________________________________________________________________
Phone 1 (______)____________________________
Phone 2 (______)_______________________________
Social Security # _____________________________
Vehicle License # _______________________________
Date of Birth (mm/dd/yyyy)_____________________
Drivers Lic. # & State ___________________________
Type of license applied for: NEW / RENEW:
1 week
1 month
6 months
1 year
($50)
($100)
($200)
($350)
DUPLICATE / REPLACEMENT:
($25)
Name(s) of employees _________________________________________________________________________
Total Badges and Cost _________________________________________________________________________
Days/Dates of planned operation _________________________________________________________________
Description of vehicle(s) or conveyance(s) used, including vehicle license numbers: ________________________
___________________________________________________________________________________________
Where will business be conducted: (Written permission from property owner is required; no vending allowed with 400’ of
the centerline of Plum Creek Parkway, between Interstate 80 and Prospect Road).
___________________________________________________________________________________________
___________________________________________________________________________________________
Description of goods sold: _____________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Please provide valid copy of Nebraska Sales Tax Permit as required by Neb. R.S. § 77-2705
Will food be vended?
Yes
No
If food is vended, provide valid copy of State Department of Agriculture Food Inspection and Permit
I have read and understand Lexington’s Street Vendor Ordinance (Ord. 2300). I certify that all information I have provided is true,
complete and correct. I expressly authorize, without reservation, the City of Lexington to contact and obtain information from
any and all agencies and licensing authorities, and to otherwise verify the accuracy of all information provided by me in this
application.
____________________________________________
_______________________________
(Signed)
(Date)
Fee: $ __________ PAID
__________________
Sales Tax Permit copied & current? ______________
Assigned number: 20___-__________
Sales Tax Permit #: _____________________________
Expiration Date: ____________________________
Food permit copied & current? __________________
Food Inspection up-to-date?
__________________
Revised 08-16-2011
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