Randall W. Teague, Mayor
Director of the Department of
Public Works, Parks, and Public Property

Paul  Dougherty,   Commissioner 
   Director of the Department of Revenue                
   & Finance

John C. Foley,   Commissioner 
      Director of Public Safety
& Department of Public Affairs		

Tele: (856) 854-1176
Fax: (856) 854-0614
Web: www.haddontwp.com	

BUSINESS LICENSE APPLICATION 

____ NEW    		    ____ RENEWAL             ____ TEMP/SEASONAL

Date Applied_______________			License No.___________________ 

Fee Paid___________________			Date Paid_____________________ 

1.	Name of Business____________________________________________________ 

	      Address of Business:_________________________________________________ 

	     Business Telephone Number:____________________  Cell Phone Number:_______________ 

	     E-Mail Address:__________________  Website:_____________________________
	
	      SS#___________________   DL#_______________________________ Date of Birth:__________

	     If person completing the Application is not the Applicant, provide the same information as above for 

	     the person completing the application:_________________________________________________ 

	     ________________________________________________________________________________

                 ________________________________________________________________________________
		
                ________________________________________________________________________________

  2.         The name and address of all shareholders, members, partners, directors, officers and registered agent(s) 
              of the Applicant:
              _________________________________________________________________________________

              _________________________________________________________________________________

              _________________________________________________________________________________

If any shareholder, member, partner or registered agent is itself a business entity of any kind, the                     applicant also must provide the name and address of all shareholders, members, partners, directors and registered agents of same:

              ________________________________________________________________________________

              ________________________________________________________________________________

3. 	Type of Business:__________________________________________________________________

Description of Proposed Business Activities:_____________________________________________

	_________________________________________________________________________________

	_________________________________________________________________________________

Hours of Operation:_________________________________________________________________

Address where business will operate:

       Street Address (if different from #1 above): __________________________________________

       Block #:_______________   Lot #:________________
                  
4. 	DATA REQUIRED TO BE PRESENTED WITH APPLICATION

The following documentation must be supplied with the application or the application will not be processed:
(a)  	Valid New Jersey Driver's License with Photograph or other Valid Government-Issued Identification with Photograph.
(b)  	Proof of authorization to conduct business within the State of New Jersey (A copy of a valid  business registration certificate issued by the New Jersey Division of Revenue.)		
(c)  	A Zoning Permit approved by the Haddon Township Zoning Officer.
	
CERTIFICATION BY APPLICANT:  I do hereby certify that the foregoing information is true to the best of my knowledge.  I am aware that if any of the foregoing information is knowingly false or misleading, my business license is subject to suspension and/or revocation.

_______________________________			___________________
Applicant’s Signature						Date

	
FOR TOWNSHIP USE ONLY:

TAX COLLECTOR CERTIFICATION:

_____	All property taxes due have been paid.
_____	All sewer and/or water utilities due have been paid.
_____	All assessments due have been paid.
_____	The following are delinquent:  Property Taxes _____   Sewer/Water _____   Assessments _____

____________________________________________                     ________________
RYAN GILES, TAX COLLECTOR (or his Designee)                      DATE

FIRE MARSHALL:   _________ Approved      _________  Denied          Date:____________

Reason for Denial:___________________________________________________________________________ 

_______________________________________                     
WILLIAM BEHNKE, FIRE MARSHALL

CONSTRUCTION CODE OFFICIAL RECOMMENDATION: 

__________   Recommend Approval    __________   Recommend Denial

Reasons:___________________________________________________________________________________

__________________________________________             _______________                   
MIKE DEPALMA, CONSTRUCTION OFFICIAL               DATE

CHIEF OF POLICE RECOMMENDATION:

__________   Recommend Approval    __________   Recommend Denial

Reasons:___________________________________________________________________________________

___________________________                   ______________
MARK CAVALLO, CHIEF                           DATE

BUSINESS IMPROVEMENT DISTRICT RECOMMENDATION:

_____ Subject Property is in the  East B.I.D. / Central B.I.D.           _____ Subject Property is Not in Either B.I.D.

_____ Recommend Approval     _____ Recommend Denial    

Reasons:___________________________________________________________________________________

______________________________              ______________
KATE BURNS, B.I.D. DIRECTOR                DATE