Peddler's Permit Application & Background Check

Exactly as extracted, unformatted — for checking against the original. The readable version is easier to read.

Permit Number:
Date Issued:
Fee: $35.00
Check#: Cash:
THE TOWN OF CENTREVILLE 101 LAWYERS ROW CENTREVILLE, MD 21617
410-758-1180 FAX 410-758-4741 WWW.TOWNOFCENTREVILLE.ORG
PEDDLER’S PERMIT APPLICATION
Applicant Name: Application Date:
Applicant Address:
Date of Birth: Phone Number:
Email Address:
Driver’s License Number: Issuing State:
Name of Home Office or Manufacturer:
Address of Home Office or Manufacturer: Phone Number:
Address of Agent designated to receive service of process in the State of Maryland:
Item or items proposed to sell:
Have you been convicted of any crime, misdemeanor, or violation of any municipal ordinance, other than a
traffic violation:  Yes  No If yes, describe
Are orders to be solicited or taken for future delivery of goods or performance of services?  Yes  No
If yes, describe
Are you soliciting for funds for the future delivery of goods or performance of services?  Yes  No
If yes, describe
If any calls are received from someone who does not wish to be bothered with the above activity, the Town
Clerk or Police Department shall notify at the phone number
of and they shall not be allowed to solicit on the specified
property(s).
The time of solicitation, peddling, hawking, vending, and canvassing shall be between the hours of 9:00 a.m.
and 8:00 p.m., except for special events.
Do you swear and affirm that the information provided above is true and correct to the best of your knowledge,
information, and belief?  Yes  No
Name (please print)
Signature Date
W:\0-PERMITS\Peddler's Permits\2022 Peddler's Permit Application Packet.doc

THE TOWN OF CENTREVILLE 101 LAWYERS ROW CENTREVILLE, MD 21617
410-758-1180 FAX 410-758-4741 WWW.TOWNOFCENTREVILLE.ORG
Peddler’s Permit
Page Two
OFFICE USE ONLY
This application must be reviewed and approved by the Centreville Police Department before issuance.
We have received, this date, from the above-mentioned name the sum of THIRTY-FIVE DOLLARS ($35.00),
per person, which represents the payment for a Peddler’s License to sell
in the Town of Centreville, Maryland, as per Town Ordinance Chapter 95 regulating parking and licensing of
peddlers and vendors on the streets of Centreville. A copy of Ordinance Chapter 95 is attached.
This permit expires on December 31st in the year it was issued.
THE TOWN OF CENTREVILLE
Town Clerk – Carolyn M. Brinkley
APPROVED:
Date Chief of Police – Robert L. Hobbs
FOR TEMPORARY PEDDLER’S PERMIT:
Town Manager – Charles M. Koogle Chief of Police – Robert L. Hobbs
APPROVED:
Date
CC: Centreville Police Department
W:\0-PERMITS\Peddler's Permits\2022 Peddler's Permit Application Packet.doc

ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK
I acknowledge receipt of the separate stand-alone Disclosure and certify that I have read
and understand it and this authorization. I hereby authorize the obtaining of “consumer
reports” and/or “investigative consumer reports” by the Town Council of Centreville at any
time after receipt of this authorization for my Peddler’s Permit until December 31st, at which
time a new report will be required, should I apply for one. To this end, I hereby authorize,
without reservation, any law enforcement agency, administrator, state or federal agency,
institution, school or university (public or private), information service bureau, employer, or
insurance company to furnish any and all background information requested by IntelliCorp
Records, Inc., 3000 Auburn Drive, Suite 410, Beachwood, Ohio 44122; Tel. No.
1.888.946.8355; www.intellicorp.net.
I also consent to have any legally required notices sent electronically.
Printed Name
Signature Date
Parent or Legal Guardian Signature Date
(for searches conducted on minors under
the age of 18)
**The Town of Centreville does not request credit reporting for any Peddler's Permit
applications. Only social security number verification and criminal background
information.
Version 7/2018

PERSONAL DATA
Last Name First Name Middle Name
Current Address
City State Zip
Dates lived here
Previous Address
City State Zip
Dates lived here
Date of Birth Other Names Used (including maiden name) Years Used
Social Security Number Driver's License # DL State
Email address (may be used for official correspondence)
Version 7/2018

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Para información en español, visite www.consumerfinance.gov/learnmore o escribe a la
Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.
A Summary of Your Rights Under the Fair Credit Reporting Act
The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and
privacy of information in the files of consumer reporting agencies. There are many types of
consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies
that sell information about check writing histories, medical records, and rental history records).
Here is a summary of your major rights under FCRA. For more information, including
information about additional rights, go to www.consumerfinance.gov/learnmore or write
to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.
 You must be told if information in your file has been used against you. Anyone who
uses a credit report or another type of consumer report to deny your application for credit,
insurance, or employment – or to take another adverse action against you – must tell you,
and must give you the name, address, and phone number of the agency that provided the
information.
 You have the right to know what is in your file. You may request and obtain all the
information about you in the files of a consumer reporting agency (your “file
disclosure”). You will be required to provide proper identification, which may include
your Social Security number. In many cases, the disclosure will be free. You are entitled
to a free file disclosure if:
o a person has taken adverse action against you because of information in your
credit report;
o you are the victim of identity theft and place a fraud alert in your file;
o your file contains inaccurate information as a result of fraud;
o you are on public assistance;
o you are unemployed but expect to apply for employment within 60 days.
In addition, all consumers are entitled to one free disclosure every 12 months upon
request from each nationwide credit bureau and from nationwide specialty consumer
reporting agencies. See www.consumerfinance.gov/learnmore for additional
information.
 You have the right to ask for a credit score. Credit scores are numerical summaries of
your credit-worthiness based on information from credit bureaus. You may request a
credit score from consumer reporting agencies that create scores or distribute scores used
in residential real property loans, but you will have to pay for it. In some mortgage
transactions, you will receive credit score information for free from the mortgage lender.
 You have the right to dispute incomplete or inaccurate information. If you identify
information in your file that is incomplete or inaccurate, and report it to the consumer
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reporting agency, the agency must investigate unless your dispute is frivolous. See
www.consumerfinance.gov/learnmore for an explanation of dispute procedures.
 Consumer reporting agencies must correct or delete inaccurate, incomplete, or
unverifiable information. Inaccurate, incomplete, or unverifiable information must be
removed or corrected, usually within 30 days. However, a consumer reporting agency
may continue to report information it has verified as accurate.
 Consumer reporting agencies may not report outdated negative information. In
most cases, a consumer reporting agency may not report negative information that is
more than seven years old, or bankruptcies that are more than 10 years old.
 Access to your file is limited. A consumer reporting agency may provide information
about you only to people with a valid need – usually to consider an application with a
creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a
valid need for access.
 You must give your consent for reports to be provided to employers. A consumer
reporting agency may not give out information about you to your employer, or a potential
employer, without your written consent given to the employer. Written consent generally
is not required in the trucking industry. For more information, go to
www.consumerfinance.gov/learnmore.
 You may limit “prescreened” offers of credit and insurance you get based on
information in your credit report. Unsolicited “prescreened” offers for credit and
insurance must include a toll-free phone number you can call if you choose to remove
your name and address from the lists these offers are based on. You may opt out with the
nationwide credit bureaus at 1-888-5-OPTOUT (1-888-567-8688).
 The following FCRA right applies with respect to nationwide consumer reporting
agencies:
CONSUMERS HAVE THE RIGHT TO OBTAIN A SECURITY FREEZE
You have a right to place a “security freeze” on your credit report, which will
prohibit a consumer reporting agency from releasing information in your credit
report without your express authorization. The security freeze is designed to prevent
credit, loans, and services from being approved in your name without your consent.
However, you should be aware that using a security freeze to take control over who gets
access to the personal and financial information in your credit report may delay, interfere
with, or prohibit the timely approval of any subsequent request or application you make
regarding a new loan, credit, mortgage, or any other account involving the extension of
credit.
As an alternative to a security freeze, you have the right to place an initial or extended
fraud alert on your credit file at no cost. An initial fraud alert is a 1-year alert that is
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placed on a consumer’s credit file. Upon seeing a fraud alert display on a consumer’s
credit file, a business is required to take steps to verify the consumer’s identity before
extending new credit. If you are a victim of identity theft, you are entitled to an extended
fraud alert, which is a fraud alert lasting 7 years.
A security freeze does not apply to a person or entity, or its affiliates, or collection
agencies acting on behalf of the person or entity, with which you have an existing
account that requests information in your credit report for the purposes of reviewing or
collecting the account. Reviewing the account includes activities related to account
maintenance, monitoring, credit line increases, and account upgrades and enhancements.
 You may seek damages from violators. If a consumer reporting agency, or, in some
cases, a user of consumer reports or a furnisher of information to a consumer reporting
agency violates the FCRA, you may be able to sue in state or federal court.
 Identity theft victims and active duty military personnel have additional rights. For
more information, visit www.consumerfinance.gov/learnmore.
States may enforce the FCRA, and many states have their own consumer reporting laws.
In some cases, you may have more rights under state law. For more information, contact
your state or local consumer protection agency or your state Attorney General. For
information about your federal rights, contact:
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TYPE OF BUSINESS: CONTACT:
1.a. Banks, savings associations, and credit unions with total a. Consumer Financial Protection Bureau
assets of over $10 billion and their affiliates 1700 G Street, N.W.
Washington, DC 20552
b. Such affiliates that are not banks, savings associations, or b. Federal Trade Commission
credit unions also should list, in addition to the CFPB: Consumer Response Center
600 Pennsylvania Avenue, N.W.
Washington, DC 20580
(877) 382-4357
2. To the extent not included in item 1 above: a. Office of the Comptroller of the Currency
a. National banks, federal savings associations, and federal Customer Assistance Group
branches and federal agencies of foreign banks 1301 McKinney Street, Suite 3450
Houston, TX 77010-9050
b. State member banks, branches and agencies of foreign banks b. Federal Reserve Consumer Help Center
(other than federal branches, federal agencies, and Insured State P.O. Box 1200
Branches of Foreign Banks), commercial lending companies Minneapolis, MN 55480
owned or controlled by foreign banks, and organizations
operating under section 25 or 25A of the Federal Reserve Act.
c. FDIC Consumer Response Center
c. Nonmember Insured Banks, Insured State Branches of 1100 Walnut Street, Box #11
Foreign Banks, and insured state savings associations Kansas City, MO 64106
d. Federal Credit Unions d. National Credit Union Administration
Office of Consumer Financial Protection (OCFP)
Division of Consumer Compliance Policy and Outreach
1775 Duke Street
Alexandria, VA 22314
3. Air carriers Asst. General Counsel for Aviation Enforcement & Proceedings
Aviation Consumer Protection Division
Department of Transportation
1200 New Jersey Avenue, S.E.
Washington, DC 20590
4. Creditors Subject to the Surface Transportation Board Office of Proceedings, Surface Transportation Board
Department of Transportation
395 E Street, S.W.
Washington, DC 20423
5. Creditors Subject to the Packers and Stockyards Act, 1921 Nearest Packers and Stockyards Administration area supervisor
6. Small Business Investment Companies Associate Deputy Administrator for Capital Access
United States Small Business Administration
409 Third Street, S.W., Suite 8200
Washington, DC 20416
7. Brokers and Dealers Securities and Exchange Commission
100 F Street, N.E.
Washington, DC 20549
8. Federal Land Banks, Federal Land Bank Associations, Farm Credit Administration
Federal Intermediate Credit Banks, and Production Credit 1501 Farm Credit Drive
Associations McLean, VA 22102-5090
9. Retailers, Finance Companies, and All Other Creditors Not Federal Trade Commission
Listed Above Consumer Response Center
600 Pennsylvania Avenue, N.W.
Washington, DC 20580
(877) 382-4357
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