Form 926 - Operator'S License Application - Village Of Brown Deer, Wisconsin Page 2
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27.
Have You Ever, In Your Lifetime, Been Convicted of Any Offense, the Result of Which Was a Penalty of a Jail
or Prison Sentence, Probation or a Fine or Forfeiture Which, Including All Court Imposed Costs, Exceeded
$100? (
)Yes (
) No If Yes, list date(s), offense, penalty and jurisdiction:
Date
Offense
Penalty
Jurisdiction
_______________
_________________________
_________________ _________________________
_______________
_________________________
_________________ _________________________
8.
Have You Completed the Training Session on Alcohol Beverage Regulations:
(
) Yes - When?_______________________ Where?__________________________ (
) No
ADDITIONAL INSTRUCTIONS TO APPLICANTS FOR OPERATOR=S LICENSES:
Read these instructions and the notice below before completing this application.
Supply all information requested on this application. Information must be accurate and complete. False information
or omissions are grounds for denying your application.
A thorough investigation by our Police Department is made on every applicant for the above licenses.
A full set of fingerprints is required of ALL NEW applicants. Fingerprints may be taken at the Brown Deer Police
Department between the hours of 8:00 A.M. and 4:30 P.M., Monday through Friday.
All license fees must be paid when filing this application.
If your application is approved, your license will be available for redemption at the Village Hall during regular
working hours, Monday through Friday, 8:00 A.M. to 4:30 P.M.
Applicant understands that information on this application and collected as part of the licensing investigation becomes
a public record and is subject to disclosure to the public upon request.
Do you owe outstanding debts to the Village of Brown Deer? (
) Yes
(
) No
Have you paid in full all personal property taxes, all real estate taxes and all fines owed to the Village for ordinance
violations?
(
) Yes
(
) No
(
) Not Applicable
An incorrect response on this statement is grounds for suspension, revocation or non-renewal of license.
I have read the above instructions and notices.
______________________
_______________________________________________________
Date
Applicant=s Signature
The above applicant, being first duly sworn on oath, says that he/she is the person who made the foregoing application and that
all information supplied is true and correct. (FALSE INFORMATION OR OMISSIONS WILL BE GROUNDS FOR
DENYING THIS APPLICATION!)
Subscribed and sworn to before me this
__________day of __________________,________
__________________________________________
(*Furnishing of the Social Security Number is purely voluntary on the
Notary Public
Milwaukee County, Wisconsin
part of the applicant. Failure to furnish the Social Security Number
My Commission Expires_______________________
will not result in denial of the application.)
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