NLPD Solicitation Permit

North Lebanon Township Police

725 Kimmerlings Road,
Lebanon, PA 17046

Name
Home Address
Address While In Area

Description of Vehicle Being Used

Are You The Driver?
Have you ever been arrested for anything other than minor traffic violations?

Nearest relative to be contacted in case of emergency

Name
Address

I verify that the facts set forth in this application are true and correct to best of my knowledge and belief. I also understand that a criminal history and driver's license check may be conducted. I agree to abide by the rules and regulations as set forth in the North Lebanon Township Ordinance pertaining to peddling:

Applicant's Consent
MM slash DD slash YYYY