Application for Vendor License

Applicant Name *
Applicant Name
Permanent Address of Applicant *
Permanent Address of Applicant
Business Phone Number *
Business Phone Number
Cell Phone Number *
Cell Phone Number
Starting Date of License *
Starting Date of License
Ending Date of License *
Ending Date of License
Is this application for a prepared food business? *
DISCLAIMER: No organization shall initially be exempt from full payment of vendor licensing, regardless of tax exempt status. Organizations recognized under Internal Revenue Code 501(c)(3) as a bona fide religious or charitable organization may submit a written request for full or partial refund by a pre-approved format to the Director of Equalization Office no earlier than 30 calendar days preceding the event or no later than 10 days after. All requests shall be considered by the Meade County Governing Board within 60 days of acceptance of the request.
Meade County Application Fee *
Are you a tattoo artist? *
State inspection fee is an additional $100 per license.
Are you performing piercing? *
State inspection fee is an additional $100 per license.
Total the amounts from the responses listed above.
NOTE: It is the responsibility of the applicant to remit payment in a timely manner. Meade County will not be sending an invoice for payment.
Affirmation and electronic signature
The undersigned applicant hereby swears and affirms that the above and foregoing statements are true and correct. I understand and agree that I am responsible for payment of the applicable state sales tax on goods/services I sell. I further understand and agree that display or sale of obscene materials will be grounds for immediate suspension of my license and that any violation of state or local laws regarding obscene materials will be prosecuted.
Electronic Signature *
Electronic Signature
(Please type in your full name)
Date of Signature *
Date of Signature
Would you like your license to be mailed or held at the Equalization Office for pick-up?