The URL can be used to link to this page

Home My WebLink AboutOnufrak, Peter ELIZA13ET14 A.NEVILLE,MMC �� Town Hall,53095 Main Road TOWN CLERK q P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ® Fax(631)765-6145 MARRIAGE OFFICER �° ® Telephone(631)765-1800 RECO ZDSA= FREED M O CER www.southoldtownny.gov M AY 2 2 2019OFFI E OF THE TOWN CLERK TOWN OF SOUTHOLD So�D$�d� d Town Clerk S Z?- Fee: $200 -.0 Application Date: $ 50 per Day APPLICATION FOR PEDDLING AND SOLICITING LICENSE 1. Name of Applicant Date of Birth 6-2-it Eye Color 8ApW Hair Az, Height C `Z Weight 2 1�D 2. Permanent Home Address e.1C V Mailing Address S c-k-r- Telephone No. 6.��- 9�� ( _(Home) 4,:?l-(o z- (Business) 3. Driver's License Identification No. Include a readable'pli6t6copy ofa)plicant's driver's license 4. Residence for;preced �g'tliree'(3� yars`. ..r:. t; 't1kCq,4,•;.,r11,5!45 5. Brief statement of the nature of the business and a description of the merchandise to be sold o� bald AkLaa cql 6. If employed, the name and address of the employer, together with the credentials establishing the exact relationship 7. A description of the vehiple beingused and its lice P se plate number 8. The name, address, and telephone number of the person from w om goods making up the stock, were and are to be purchased 9. Two (2) photographs of the applicant taken within sixty (60) days immediately prior to the date of the application, which photograph shall clearly show the head and shoulders of the applicant and shall measure 2 '/2x 2 '/2 inches shall be submitted together with this application. 10. Three (3) business references located in the County of Suffolk, State of New York, together with their addresses and telephone numbers. e , r i , 11. A statement as to whether the applicant has been convicted of any crime, misdemeanor or violation of any municipal ordinance, the nature of the offense and the punishment or penalty assessed. A/0 cit C i d 12. Fingerprints of the applicant. (Attach to application) County of Suffolk) SS: r State of New York) 0Ne,4 Fig Being duly shown deposes and says that he/she is the applicant for the peddling/soliciting license, and that all statements contained herein are true to the best of his/her knowledge and belief, that the business conducted will be done in the manner set forth in this application. The applicant agrees to hold the Town of Southold, Town Board and Town Clerk harmless and free from any and all damages and claims arising undcr.or by virtue of said.license, if granted. Legal signat a of applicant Sworn to before me this 0 day of 2 0( . SABRINA M BORN Notary Public Notary Public,State of New York No.01 B06317038,Suffolk County Commission Expires Dec.22,20 26 Attachments to the application shall include: 1. Two (2) photographs 2. Letter from the firm or corporation for which the applicant works, authorizing applicant to act as its representative. (if applicable) 3. Physician's statement, dated not more that ten (10) days prior to the submission of the application, certifying the applicant to be free of contagious infections or contagious diseases. 4. Authorization certification from the New York Sales Tax Bureau 5. Copy of applicant's driver's license Applicant must have fingerprinting and background check performed before applying. (For office use only) I have reviewed the foregoing application of Peddling and Soliciting License and recommend approval rejection of same. (check one) Chief of Police/or Officer in Charge Southold Town Police Department Y 11. A statement as to whether the applicant has been convicted of any crime, misdemeanor or violation of any municipal ordinance, the nature of the offense and the punishment or penalty assessed. p 64 12. Fingerprints of the applicant. (Attach to application) 4' County of Suffolk) SS: State of New York) .•,,,r ¢•r /:2e14 CONN Being duly shown deposes and says that he/she is the applicant for the peddling/soliciting license, and that all statements contained herein are true to the best of his/her knowledge and belief; that the-business conducted will be done in the manner set forth in this application. The applicant agrees to hold the Town of Southold, Town Board and Town Clerk harmless and free from any and all damages and claims arising+und6por,by.virtue of said.license, if granted. 7. Legal sign at a of applicant Sworn to before me this Z day of { 2 00 SABRINA M BORN Nota Public Notary.Public,state of New Ybrk �' No.01806317038,Suffolk County Commission Expires Dec.22,20 :22' Attachments to the application shall include: 1. Two (2) photographs 2. Letter from the firm or corporation for which the applicant works, authorizing applicant to act as its representative. (if applicable) 3. Physician's statement, dated not more that ten (10) days prior to the submission of the application, certifying the applicant to be free of contagious infections or contagious diseases. 4. Authorization certification from the New York Sales Tax Bureau 5. Copy of applicant's driver's license Applicant must have fingerprinting and background check performed before applying. (For office use only) I have reviewed the foregoing application of Peddling and Soliciting License and recommend approval rejection of same. (check one) Chief of Police/or Officer in Charge Southold Town Police Department sz Ly E �ZC�O66EAGIt Ad1�E�i�C10EN$E � " pr r 1 -13n .T 397 640 OU1 7 fr M 4TTiTtlCK NY 179 2 V's r , ;fax M.,tryHFs tib Em BRO 'dsz� D08QCIQ�lwj�� i��'t�s�, ' F•�, �� r.,,�? e C'ELSI 3 Issued'.D 6l2D 14616 - o 9-0. c o .' a l4 Q 8 o� es b �a `S•. f� , �, � . g�y¢ � � ., r o 0 o yo ° -' � ' �"e�;✓ - �a•r�i a •.. a — — �I �� f ® a �. � �. 4 m ® m � " . a. 0 � � o . ' ,. . m ({4Z . a �� t n a °'� a °, � 6 e ,� ;. ® a .. ,. @- o o a a -o a a _ e o ' T � r � � � @ 0: 8 a 0 S a �4 b a O 4 .'.O �3 6 � " � � � � m ��n. °:ins �a4�o u � � as p � , '. .. r r.NEW YORK STATEINSURANC.4 IDENTIFICATION CAR®a. LIBERTY MUTUAL iib 6 jB.LM-GENERAL INSURANCE,COMPANY. 05 2 3485-70 8 p,0.Box 970 3 Mishawaka,IN 46546 Name&Address of Issuer '— Effective"Date Expiration Data r 175'BERKELEY STREET . 4It -.;; os1�18 03/13/2019 For Customer Service:/-800225 7014 BOSTONi MA 02116 4i•a`:. , 12.01 a:m ' 12.01 a.m. For Claims:1-800 225 2467 An authorized NEW YORK insurer has issued an Owner's_ (Not acceptable to obtain registration after Roadside Assistance: 1-800-426-9698 Policy of'Uability Insurance complying with Article:6(Motor 45 days from effective date.) Report,all accidents promptly,telephone - - !, Vehicle Financial Security.Act)of the NEW YORK Vehicle and.. Applicable with respect to the following the nearest Liberty Mutual Office if the Traffic Law to: Motor Vehicle accident involves another occupied 13t `. LINCOLN yahaccident (even though no injuries claimed), yc, GRECO-ONUFRAK,GLORIA 2002, a:pedestrian,or any personal injury or !ONUFRp,K,PETER,P Make property damage. tt' 1500 NIARYS RD 1LNHM97V.9.ZY700810 MAT:TITUCK NY 11952-1649 Vehiclezld®r Ufication Number S { gwy `fits � ..��. � � ~' k<cts�'*^t�«' �'.. „� �' �s -'p,T•.,• , Liberty r� mutuil. •.':txo ' = P �r t._.. INSORANCE r NO, ^1A `*� r �,�^,,,P}, �«'^��" ,:5S{,.�^,gtk � '°"d'z` ,�3^�� {A � vS;I' e •• • • • •• • • I r a t `&!t'� '�T?�Ssa. �� .�^F!y"� �-,N -w {'{C" C4�r� �.,.. _... r- ^ti •�• c I 7r:�a��,. ` �"��, '��r``T:'�� t'�''�r','�t.�. ^+s., �.��T`��?t�`c�# �.* ,•n� $' �; x _ :•rZ ,iY KSTATE�REGIS�jRA O1V-',POCSJMENTr'. -� �,,k��j � 4�r ht $ sI r t" y� � � ,�.,� �".:7•K,� ...y`"`.�,7- �[.,;.�"+ '°; '�''�� i 4,*'' 'tla'."Y. r•5$...�,..,, t�p, < .Y' S' rr1•(,, = s.eyhti'ti>a �' ... �7:"r•P �•y yrr.. .i.^ `_ :i t r r+^«•,{$' i ` Ff.T4t• 1 n= t is 'azS,, fz* 2a` ?r3, rs "" # #w,ac '�y"`,t1 -7•'2-O? a� �� ' , •A ..- J .t: r v MV� � � ,� 'ry r.ga2,0:02 ItiIIvCO. N .Z72'RANSEERABIrE. g"xy'L ,1 :�•',i3O� ``in,"l" ass 'F ° �' + '?r�'°" - �• , t � � y Y ,; SSD �TN�=;,';�TLIyH1vh97V�2Y�7Q0810 7 �s � -. u ' � �' 0: 7 -5 •�G 8�HE364-444DE' �0? by , � Y � r _ r ° . >a�ucl -HAG RVH 62.4'M. !' '` -#� c+ to 4�-"r f.;•F ° "M -z _ , r. =t . t-„le.yr.} L*z ''{ •q1 -j'- L[ T 1�'its+t"a `4 a 3« 3. �"'•< n�vL P:y. -*3t\'c` Y,..ra s j+i.�'} §,. 3a� •`` .�r�Y. Ei fres. 2.0 12 0.6% t# t"cY��e�� s��\ ; P ''*-N= �* 7 �jJ.F�IRK; PE'�'ER"l - Y sem ge r. .i 1">$O&'MARYS >Rb 30 Z5 , ,..• ,� r rr;t #�€` Pf\�z'�' t:"5 ,�:f :'� ,tam. ' i 4i x yMA22IT:UCK:. NY 11952---. h: ''F �"-.��'. .- ANNUALGSC'1 .1 Y € L`it= i +� - k r� r P 1 rTb s-s P._'- P.\ID IL\CL ADDC114�'t ry\ 'os4i a +dzi��,st EXCE7. ?nADDRE.3 <6. 5.. 0 oP 4 7 P.. Ti `+ x f*• bi�y�i3'5,S�$1 ' .1.. .. A -`+ ` - 11. 11 R � Xylull S 1 I "? MT- x„z �T-s'c'°`7` Sa P �•}�e,� ! :. .4 a 'n:.t C �kRT�",r�i3* 5e-i '4”"" ".n'#L ' �'zys: a 3rz .t t �i !� �\'U�--r a �• `�'�#�n t'� '. t 5 �P� '?F r`f k P 0.>`>''a ,�v f. '^` ' -•;r� a� tv 5.� .�zck*- �`'y^.«. t -.n' ,. t,.Z t'w�•,«-'^��-'^�r+�r ,� zn ,y '"� - i, M:,7 s �+ a r ' � tf.:.Ate ,��`w-d'1j nI •P�;t c.- KSx'tns'f€iryrt .. � , yzam ra t � r - i 0.'a ✓" {f ixvat', f -r{, e;= g+ tlW"Tj } f �.. ' t,I �ar--.I` ,�^S�a.S�„''�z "t Y t 4 KtX, F q} €y tZa, ,:.•� t }.i it ,3yj "y r_fl w. •ct � "t �'�'�e t.;�s .e4tYz 'k r��¢ ms's �t - k NYU Langone Health Katie Hough, DO MATTITUCK PRIMARY CARE 11700 MAIN ROAD MATTITUCK NY 11952-1592 Phone: 631-635-5440 Fax: 631-315-5510 May 22, 2019 Patient: Mr. Peter P Onufrak Date of Birth: 6/2/1943 Date of Visit: 5/22/2019 To Whom it May Concern: Mr. Peter Onufrak was seen in my office on 5/22/2019, And was found to be free of contagious infection and diseases. If you should have any questions or concerns, please don't hesitate to call. Sincerely, Katie Hough, DO AMMIRATI'S OF LOVE LANE 135 LOVE LANE MATTITUCK,NY 11952 631-298-7812 April 25,2019 TO WHOM IT MAY CONCERN, I have known Mr. Onufrak for the last 10 years, he is an upstanding member of the community and has my full support. :Thank you, Step en Ammirati, owner Unit2Go PO Box 946 Cutchogue, NY 11935 To whom it may concern: I have known Pete Onufrak for 10 years. I have always known him to be of high character both personally and in business. He and his family have rented multiple'storage units from me, and his granddaughter plays sports with my daughter. Pete is an active and productive member of our community and I hold him in the highest regard. Sincerely, Od 5� - Martin Kosmynka Greenport Wine8and80iriL8 132 FRONT STREET GREENPORT NY 11944 • 631.477.6701 • FAX 631.477.6702 23 April 2019 To whom it may concern; It has been our pleasure to know Peter Onufrak since we opened our store 10 years ago. He and his wife operated a framing shop/art studio next door. He has always been an honest, straightforward and professional person. He's a gentleman who never failed to treat us with generosity and respect. Sinc rel , 1 Deb Gove Greenport Wines and Spirits a � e o- c3: o o- ® F y' a �� 0 0 0 � ° , � � �.�` fi, , � �. . �y � ,.; r; 1, G' w A� s - A o ao A: - d �` _ . ., C. -;.. _ :, �� • c e n ..m p � A m � �� ®. �® � e o. � � �� 0 `0 0 OA - 6 � � 6' ° � °n 0 0 A � `e,. O -' '' '. µ .. _. � q x SA' 0.0 '.0 4 0 "8 0 O O A 0 0 O O00' 1 0 O 0� O "0 p.. a . .. a ` A. e O 0' 0 0 0 AO »i A 0 O B �0 t � ,. � r , ��77 g� gg�� gg gg�� qq - � C1 t9 i8 A Ld iF U ® b � � . �s a w. a � � Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 05/22/19 Receipt#: 254503 Quantity Transactions Reference_ _ Subtotal 1 Permit-Year 5122/19 _ $200.00 -1 Permit-Year 5/22/19 -$200.00 Total Paid: $0.00 Notes: X-yol -hk Volk �v a pl i Payment Type Amount Paid By 4rOA Foy- JJ 9-003, Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Onufrak, Peter 1500 Mary's Rd Mattituck, NY 11952 Clerk ID: SABRINA Internal ID:5/22/19 e 11. A statement as to whether the applicant has been convicted of any crime, misdemeanor or violation of any municipal ordinance, the nature of the offense and the punishment or penalty assessed. p Cit♦ n-• {j s. 12. Fingerprints of the applicant. (Attach to application) ,;a�i County of Suffolk) SS: State of New York) 1�el{ JA- /N Being duly shown deposes and says that he/she is the applicant for the peddling/soliciting license, and that all statements contained herein are true to the best of his/her knowledge and belief-, that the business conducted will be done in the manner set forth in this application. The applicant agrees to hold the Town of Southold, Town.Board and Town Clerk harmless and free from any and all damages and claims arisingsunderitp by virtue of said_H,4e se, if granted. Legal signat a of applicant Sworn to before me this �day,of f�. 201q• �' SABRINA M BORN Notary Public Notary' Public,State of New York No.01B6017038;Suffolk Coun commission Expires Dec.22,20 Attachments to the application shall include: 1. Two (2) photographs 2. Letter from the firm or corporation for which the applicant works, authorizing applicant to act as its representative. (if applicable) 3. Physician's statement, dated not more that ten (10) days prior to the submission of the application, certifying the applicant to be free of contagious infections or contagious diseases. 4. Authorization certification from the New York Sales Tax Bureau 5. Copy of applicant's driver's license Applicant must have fingerprinting and background check performed before applying. (For office use only) 1 have reviewed the foregoing application of Peddling and Soliciting License and recommend approval rejection of same. (check one) Chief of Police/or Officer in Charge Southold Town Police Department j ykw Ef''1fb0� t AuthorityJ of' 1, -AW Idbhfifild'atidn' F 11A Tv'E VA"L, MU M.TbEir':- t df Jli 2 �F-36-88iit Ij r4 tf M&Ihis rV1,71"b e-r"J',on,ain U 7 1 6 -20 1'IS' Pnrd I IPR It 7 r4' at dfje&'�,i aco,,, ,,p 'PETER'RONUFRAAK t."04! in '!5 ',4k "i %,,,�,, ,, I I, " T, UMPY P1, PETER ONUFRAK -S, ARNMOb RD, ,Ij ll,�l g 1, 1XV ;q, 16aN il S aU taxes--und; th drize sales and use, erA toles 8�,,an,.:29�o, , iI Ilw�-�Mhtfib 7mb ii�;6 dtibite'��6if bd'�]p prominently displayed at;your cbtfterim, IM 'Fraudulen't IF, T- t b 'h a e.may ind ,e�p o ocopie- or,reproduced- �'t �p px� 12 "Mi 4'fDB6---':,1,080635f ;P0000314 01 S L:z Neville, Elizabeth From: Neville, Elizabeth Sent: Wednesday, September 11, 2019 2:00 PM To: Burke,John; Duffy, Bill; Hagan, Damon; Silleck, Mary Cc: Bo rin ,D gQruski;Borg Rudder, Lynda; Smith,Jennifer Subject: Peter Onufrak- Peddlin A'li I called Mr. Peter Onufrak a few moments ago and asked him to come to the Town Clerk's Office Q-get his Peddling Permit Application and $200.00 cash which I am holding in the safe. I told him the Town Attorney has determined that I cannot issue him a Peddling Permit. He refused to take the application and money back and told me to keep it in the safe. He said he will be suing the town. Elizabeth A. Neville, MMC Southold Town Clerk,Registrar of Vital Statistics Records Management Officer;FOIL Officer Marriage Officer PO Box 1179 Southold,NY 11971 Tel.631765-1800,Ext.228 Fax 631 765-6145 Cell 631466-6064 1 a _ POO F01 ELIZABETH A.NEVILLE,MMC 0� ®Gy Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS coo • Fax(631)765-6145 MARRIAGE OFFICER ,f. �. Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER 0,( �`>� www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD I have received my incomplete "Peddlers Permit Application", together with my$200.00 cash fee paid on'5/22/2018 back from the Town Clerk's Office. .✓ 12,,Dated: Z� � !/ s/s Peter Onufrak s/s. Clerk DOE