Form Bra-4 - Application & Instructions For A Dog License Code-701 Page 2
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2GOVERNMENT OF THE DISTRICT OF COLUMBIA
DEPARTMENT OF CONSUMER AND REGULATORY AFFAIRS
BUSINESS REGULATION ADMINISTRATION
GOVERNMENT OF
THE DISTRICT
One Stop Business Center, Room #1100, 941 North Capitol Street, N.E.
OF COLUMBIA
Washington, D.C. 20002
BRA-4 (10/96)
(202) 442-8957
APPLICATION FOR D.C. LICENSE
(PLEASE PRINT IN INK OR TYPE)
For Period ______________ To ________________
I.D.
AUDIT #
TYPE OF LICENSE:
CUSTOMER NO:
CATEGORY NO:
For Official Use Only
FEE:
TAX #
Paid and Issue Date
PLEASE READ INSTRUCTIONS
2. Telephone No.
3. D.C. Ward
MPD
1. Name of Applicant
4. Home Address of Applicant
City
State
5. County
6. Zip Code
7. Applicant Named Above will be Employed By: Company or Corporation
F&R
8. Address (Street)
City
State
Zip Code
9. Signature Of Owner or Manager
Title
I&E
10. Vehicle Operator’s License Number
State
Expiration Date
11. Date of Birth
Month
Date
Year
Height
Weight
Color of Hair
Color of Eyes
Place of Birth
12. List any arrest indictments or convictions (except traffic) including dates: If non, so state
BID
13. If non-resident, List name and D.C. Address of person to receive notices
Name:
Address
14. Signature of Person to receive notices
15. Telephone No. (Local)
B
A
UNDER NO CIRCUMSTANCES WILL THE APPLICANT
WHILE WORKING AS A PARKING ATTENDANT BE
How many years have you been a resident of D.C.? ________
REQUIRED TO, ALLOW TO, OR ACTUALLY OPERATE
C
ANY MOTOR VEHICLE.
Are you a U.S. Citizen? ______________________________
D
How long have you been a resident of the D.C. Metro area?
_________________________________________________
E
How long have you been in business or regularly
employed in D.C.? _______________________________
Employer Signature
HAVE YOU COMPLETED ALL ITEMS?
PENALTIES FOR FALSE INFORMATION
16. Applicant Signature
Date
PLEASE RETURN ALL THREE PARTS OF THE APPLICATION
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