Town Of Prescott Valley Business License Division

Peddler's License

Apr 10, 2024
submission #153
Peddler's License Application

Applicant Information

First Name gloria
Last Name murrieta
Home Address (No PO Boxes) ---
Phone Number ---
Date of Birth ---
Weight ---
Height ---
Sex ---
Hair Color ---
Eye Color ---
Driver's License # ---
DL State Issued ---
DL Expiration Date ---
Social Security # ---
Have you ever been convicted of any crime, misdemeanor or violation of any municipal ordinance other than traffic violations? ---