City of Cape Girardeau, Missouri

401 INDEPENDENCE
P.O. BOX 617
CAPE GIRARDEAU, MO 63702
Phone: 573-334-1332 Fax: 573-335-7946

Application for Adult Entertainment License For Manager, Server or Entertainer

City of Cape Girardeau Seal
Fee: $20.00
Name of Applicant ___________________________________________________________
Home Address ______________________________________________________________
City, State, ZIP _____________________________________________________________
Date of Birth _________________ Place of Birth ___________________________________
Social Security # ______________________ Home Phone # __________________________
Height ___________ Weight ___________ Hair Color _________ Eyes ________
Occupation (Circle One) Manager Server Entertainer
Adult business for whom applicant intends to work: __________________________________
Business Address ___________________________________________________________

I, the undersigned, hereby apply to the City of Cape Girardeau, State of Missouri, for an adult entertainment license. I understand and agree that if I fail to supply all the information requested on the application or if any information given is untrue, application may be denied. I also understand that this application may be denied if the adult business for whom I intend to work does not have or is ineligible to receive an adult business license from the City of Cape Girardeau, Missouri.

___________________________
Date		 ____________________________________
Signature

Please bring photo identification with proof of age when applying and picking up license card. (Applicant must be 18 years of age when the application is submitted.)

This application has been reviewed for accuracy. The license is hereby authorized to be issued.

___________________________
Date		 ____________________________________
City Manager Signature

For Manager, Server, or Entertainer

STATE OF MISSOURI

COUNTY OF CAPE GIRARDEAU

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__________________________________, of lawful age being first duly sworn upon oaths, depose and say that (he, she) has read this application and the instructions with reference thereto and that (he, she) fully understands the same; that (he, she) knows the contents and the statements contained therein and that the same are true. Applicant has personal knowledge of the information contained the application and has read the provisions of Article XV of Chapter 15 of the Code of Ordinances of the City of Cape Girardeau, Missouri

________________________________________

Subscribed and sworn before me this __________ day of ___________, ___________.

________________________________________
________________________________________
Notary Public

My Commissions Expire:
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