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2. PLEASE NOTE

   This Business License Applicant Affidavit Form is a necessary piece of the business license process and must be filled out. However, all applicants must first register and apply for a license in Community Core.  If you haven't already registered and applied, click here for a guide on how to start that process before completing this form.

4. Name:*
5. Address*
7. Email:*
8. Phone number*
10. Name of Business:*
12. The applicant affidavit must be completed after the business has registered and applied for a license in Community Core. Please select the type of business license application you filled out. Then, complete the form, including the "Applicant Affidavit.*

    1. General Business License
    2. General Business License for private residence
    3. Special Issuance Business License (A) (Peddler and Solicitor)
    4. Special Issuance Business License (B) for Mobile Home Park
    5. Special Issuance Business License (B) for Pawnbroker
    6. Special Issuance Business License (B) for Secondhand Dealer
    7. Special Issuance Business License (B) for Trash Collector/Trash Hauler
14. Signature for Home Occupancy

    NOTE: Any business owner operating a business in a RENTED residence must include a completed Landlord Statement with their Business License Application.

    If granted, I/We the undersigned, agree to comply with the Wellington Municipal Code Section 15-4-30 and any other stipulations as required by the Wellington Land Use Code. I/We hereby depose and state under penalties of perjury that all statements submitted within this application are true and correct to the best of my knowledge.

16. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
18. Electronic Signature*
19. Date*
21. Special Issuance Business License (A) (Peddler and Solicitor)

    Acknowledgement of Identification Badge and Fingerprinting or background check requiements

23. I hereby acknowledge that I, the applicant, and all persons acting on behalf of my business are required to carry and/or wear a Town-issued identification badge while conducting business in Wellington and that I/we am/are required to display it to any resident or Town official upon request.*
24. I hereby acknowledge that I, the applicant, and all persons acting on behalf of my business may be required to submit to fingerprinting and/or criminal background checks.*
26. Special Issuance Business License (B) for Mobile Home Park
28. Does the Applicant have a 10% or more equity interest in any other business?*

    1. Yes - Provide financial statements from such businesses and personal financial statements with application
    2. No - Provide personal financial statements with application
29. Proposed name of Mobile Home Park:*
31. Affirmation of compliance with the town of Wellington Municipal Code, Land Use Code, and Building Regulations*

    I, the applicant, hereby affirm that the mobile home park referenced in this application will be subject to and will comply with the Town of Wellington’s Municipal Code regarding Business Licensing for Mobile Home Parks (WMC Ch. 6, Art. 4), the Town’s Land Use Code (WMC Ch. 15), and the Town’s Building Regulations (WMC Ch. 18)

32. Acknowledgement of review by Planning Commission and/or Board of Trustees*

    I, the applicant, hereby acknowledge that this application will be reviewed by the Planning Commission with a recommendation from the Town Administrator/Clerk in accordance with WMC Sec. 6-4-40 and that I am required to appear before the Planning Commission to answer questions presented by the same. Further, I understand that if this application is denied by the Planning Commission that it will be referred to the Board of Trustees for further consideration

34. Special Issuance Business License (B) for Pawnbrokers
36. Affirmation of Compliance with The Town of Wellington Municipal Code*

    I, the applicant, hereby acknowledge that the business referenced in this application will be subject to and will comply with the Town of Wellington’s Municipal Code regarding Business Licensing for Pawnbrokers (WMC Ch. 6, Art. 5)

37. Acknowledgement of Review by Board of Trustees and Inspections*

    I, the applicant, hereby acknowledge that this application will be reviewed by the Board of Trustees accompanied by a recommendation of the Town Administrator/Clerk in accordance with WMC Sec. 6-5-40 and that the referenced business may be subject to inspections by the Town Administrator/Clerk and or designated law enforcement officials.

39. Special Issuance Business License (B) for Secondhand Dealer
41. Affirmation of Compliance with The Town of Wellington Municipal Code*

    I, the applicant, hereby acknowledge that the business referenced in this application will be subject to and will comply with the Town of Wellington’s Municipal Code regarding Business Licensing for Secondhand Dealers (WMC Ch. 6, Art. 6)

43. Special Issuance Business License (B) for Trash Collector/Trash Hauler
45. Affirmation of Compliance with The Town of Wellington Municipal Code*

    I, the applicant, hereby acknowledge that the business referenced in this application will be subject to and will comply with the Town of Wellington’s Municipal Code regarding Business Licensing for Trash Collectors (WMC Ch. 6, Art 7)

46. Acknowledgement of Review by Board of Trustees and Inspections*

    I, the applicant, hereby acknowledge that this application will be reviewed by the Board of Trustees in accordance with WMC Sec. 6-7-20.

48. Applicant Affidavit

    This application has been examined by me and the statements made herein are made in good faith, and to the best of my knowledge and belief, are true, correct, and complete. I understand that this document may contain information releasable under the Colorado Open Records Act if deemed necessary by the appropriate authority. Furthermore, I understand that any business, tax, or other license issued by the Town does not allow me to conduct or maintain any business, occupation, or activity prohibited by law. I affirm that all actions of the business will fully comply with the same, and I understand that fines, probation, and other legal action may be levied against me or my business by the Town of Wellington or other such appropriate governing entities for failures to comply. I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct.

50. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
52. Electronic Signature*
53. Date*
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field