1091 Hospital Road, Franklin IN 46131 Administration: 317-736-9155Investigations: 317-346-4615Jail 317-346-4716 Fax: 317-736-2200

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    List the most recent 3 cities, towns, or counties in which you have conducted business activities similar to those you are requesting a Johnson County permit for:


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    ELECTRONIC SIGNATURE AGREEMENT
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    By typing your name in the following field, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. You consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise provide the Johnson County Sheriff's Office or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and the Johnson County Sheriff's Office. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your information and that such persons will be bound by the terms of this Agreement. You further agree that each use of your E-Signature constitutes your agreement to be bound by the terms and conditions of the Johnson County Sheriff's Office.

    I hereby authorize the Johnson County Sheriff's Office to perform a criminal background check to verify information disclosed on this application.
    I AFFIRM, UNDER THE PENALTY OF PERJURY, THAT THE REPRESENTATIONS AND ANSWERS IN THIS APPLICATION ARE TRUE.