3/7/2023 Version 1.0 Page 1 of 1
ROGER D. EATON
CHARLOTTE COUNTY CLERK OF THE CIRCUIT COURT AND COMPTROLLER
350 EAST MARION AVENUE
PUNTA GORDA, FLORIDA 33950
HOME SOLICITATION PERMIT
APPLICATION
Application Information: Permit#___________________
Name: ____________________________________________________________________________________________
Last First Middle
Date of Birth: ____________________________ Race: ____________________ Sex: _______________
Permanent Residence Address: ________________________________________________________________________
Local Residence Address: _____________________________________________________________________________
(if different from above)
Email address: _________________________________________ Phone No.: _____________________________
Driver’s License No.: ____________________________________ State of Issue: ___________________________
Have you ever been convicted of, or plead guilty or nolo contendere to any crime? ______________________________
If yes, what was the nature of the offense? _______________________________________________________________
What was the disposition? ____________________________________________________________________________
Employer Information:
Company Name/DBA: _____________________________________________ Type of Business: ____________________
Address: ______________________________________________________________ Phone: ______________________
I certify that the information contained on this application is correct and complete to the best of my knowledge, and understand
that falsification of this application in any detail may be grounds for denying issuance of my Home Solicitation Sale Permit. I
understand that the fee required for the processing of my application is non-refundable.
Signature: ___________________________________________________ Date: _________________________
Sworn to and subscribed to me this ______________ day of _______________________________, ____________.
Roger D. Eaton
Clerk of the Circuit Court (SEAL)
By:___________________________________
DEPUTY CLERK
Fingerprinting via Live Scan is required before submission of this application to the Clerk of the Circuit Court and
County Comptroller. Provide ORI number FL7081102 to the Live Scan Service Provider. A fee is required for this
service.
Transaction Control Number (TCN) provided by fingerprint agency: _______________________
