CAPSS
Licensing
Rocklin Police Department
Application For Secondhand Dealer Or Pawnbroker License
Required fields are denoted with an asterisk
A. Type of Application
Application For Pawnbroker License (21300 FC)
Application For Secondhand Dealer License (21641 B&P)
B. Licensing Agency
Name
Rocklin Police Department
ORI
CA0310400
Mailing Address
4080 Rocklin Road
Rocklin
,
CA
95677
C. Business Owner(s)
Name
DOB(mm/dd/yyyy)
Title
Home Phone
Remove Owner
D. Business Information
Name
Phone
Address Line 1
Address Line 2
City
ZIP Code
Business Ownership
INDIVIDUAL
PARTNERSHIP
CORPORATION
Corporation
Name
Phone
Corporation Address
Address Line 1
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Marshall Islands
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
NJ
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Unknown
ZIP Code
E. Off Site Storage Location
Will property belonging to the business be stored off the business premises?
Yes
No
Off Site Storage Address
Address Line 1
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Marshall Islands
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
NJ
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Unknown
ZIP Code
F. Multiple Secondhand Dealer or Pawnbroker Businesses
Do any of the parties to this application have a financial interest in any other secondhand dealer or pawnbroker businesses in California?
Yes
No
Other Pawn or Second Hand Business Information
Name
License Number
Phone
Other Pawn or Second Hand Business Address
Address Line 1
Address Line 2
City
ZIP Code
Additional info reported to LEA
Remove Business
G. Store Administrator
Name
Phone
Email Address
Verify Email Address
H. Certification
As the person responsible for completing the application for the business, I certify under penalty of perjury that the information on this application is true and complete to the best of my knowledge.
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