Owner's Application for License to Operate a Massage Business

Business Information
Address

Suite, etc.

Nature of Ownership
Corporation Information
Address of Agent

Apt., Suite, etc.

List names and addresses of any Operator(s)/Manager(s) or other persons principally in charge of operation and all employees.

Full Name Address Operations
person
Partnership Information

List partners.

Full Name Address Phone

Have any of the partners listed above ever been convicted of a felony, a crime involving moral turpitude, a crime involving controlled dangerous substances, an offense involving sexual misconduct, or any offense involving the use of force or violence upon someone, or another crime that would amount to a felony? If your answer if yes to any of the above questions, explain in detail.

Authorization
I, the applicant, do hereby authorize the City of Moore, it`s agents, or anyone designated by the City of Moore to contact any source to verify the information supplied in this application.
Verification
I, the applicant, under penalty of perjury do hereby declare that I have examined this application and all statements contained herein and to the best of my knowledge and belief, they are true, correct, and complete.
Applicant Information
Address
Two (2) Previous Addresses Prior to Current Address
Previous Address One
Previous Address Two
Physical Description

Have you ever been convicted of a felony, a crime involving moral turpitude, a crime involving controlled dangerous substances, an offense involving sexual misconduct, or an offense involving the use of force or violence upon someone, or another crime that would amount to a felony? If your answer is yes to any of the above questions, explain in detail.

List all prior Massage Establishments or similar business history and experience for the last ten (10) years.

Have you ever had a prior license to operate a massage establishment in this or any other City or State denied, revoked, or suspended? If yes, state the reason.

Authorization
I, the applicant, do hereby authorize the City of Moore, it`s agents or anyone designated by the City of Moore, to contact any source to verify the information supplied in this application.
Declaration
I, the applicant, do hereby authorize the City of Moore, it`s agents or anyone designated by the City of Moore to contact any source to verify the information supplied in this application.

List Three (3) Adult Residents in this County, other than relatives or business associates who would serve as character references.

Full Name Address Phone

VANESSA KEMP
City Clerk
[email protected]

CITY CLERK`S OFFICE
City Hall
301 N. Broadway
Moore, OK 73160

405-793-5020