HomeMy Public PortalAboutSolicitor & Canvassing REG Form IND (94-D-15)/G
1630
Watertown Police Department
1 552 Main Street, Watertown, MA 02472
(617)972-6500
TERTO/
SOLICITOR & CANVASSING REGISTRATION FORM
FOR INDIVIDUALS
Watertown City Ordinance — Chapter XIX
Except as may be expressly provided herein, it shall be unlawful for any person or organization to engage in soliciting or canvassing,
as those activities are defined in Section 3 of this ordinance, within the limits of the Town of Watertown without first registering with the
Police Department in accordance with Section 4 of the ordinance. The registration requirement of this ordinance shall be in addition
to any requirements for registration imposed by Massachusetts General Law C.101, §34.
In compliance with the above section, the Ordinance requires the following information:
Name: Date of Birth: Social Security #:
Address & Length of residence at this address:
If less than 3 years residence at this address, list the addresses of residence(s) during the past 3 years:
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ORGANIZATION OR PERSON THAT YOU REPRESENT
Name: Address:
Telephone Number:
Length of time you have been associated with or employed by this organization or person:
List Names & Addresses of employer(s) during the past 3 years if other than above:
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Period of time for which Certificate of Registration is needed:
Note: No certificate may be granted for longer than 90 days.
List names of last three communities (if any) in which you have solicited or canvassed door to door:
If any vehicle is to be used by you while soliciting or canvassing list the following:
Make:
[Model:
Color:
Reg#
Reg State:
NOTE: A RECENT PASSPORT SIZED PHOTOGRAPH OF THE APPLICANT IS REQUIRED
Date: Signature:
APPROVED:
Chief of Police Date
Watertown PD Form 94-D-15