The per­son desir­ing a license may obtain the same by mak­ing appli­ca­tion with the Coun­ty Clerk and pro­vid­ing the fol­low­ing information:

(A) Name and phys­i­cal descrip­tion of applicant.

(B) Per­ma­nent home and address and local address if oper­at­ing from such an address.

(C) A brief descrip­tion of the busi­ness and of the goods to be sold.

(D) Name and address of the employ­er, if any.

(E) The length of time for which the right to do busi­ness is desired.

(F) Evi­dence that the agent is act­ing on behalf of the cor­po­ra­tion he represents.

(G) State­ment of the applicant’s crim­i­nal record, oth­er than a traf­fic record.

(H) The last three (3) cities, vil­lages, and/or coun­ties where the appli­cant car­ried on busi­ness imme­di­ate­ly pre­ced­ing date of appli­ca­tion and the address from which such busi­ness was con­duct­ed in those munic­i­pal­i­ties or counties.