Fillable APPLICATION FOR WAIVER OF BOATING REGULATION (New Jersey State Police)

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APPLICATION FOR WAIVER OF BOATING REGULATION (New Jersey State Police)

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S.P. 660 (05/17)
1
NEW JERSEY STATE POLICE
MARINE SERVICES BUREAU
APPLICATION FOR WAIVER OF BOATING REGULATION
NEW APPLICATION FOR WAIVER
RENEWAL APPLICATION FOR WAIVER
ORGANIZATION/INDIVIDUAL NAME: AREA CODE & TELEPHONE:
ADDRESS: (Street, P.O. Box) CITY: STATE: ZIP CODE:
EMAIL: WEB/URL ADDRESS:
APPLICANT IS:
(Check One)
Individual Civic, Politic, or Social Organization Commercial Entity
NAME OF PERSON COMPLETING APPLICATION: (If Different than Above) AREA CODE & TELEPHONE:
ADDRESS: (Street, P.O. Box) CITY: STATE: ZIP CODE:
RELATIONSHIP TO ORGANIZATION:
Identify the Regulation, Rule, Statute, or Legal Authority from which you seek a Waiver:
Explain briefly your reason for the Waiver Request:
In support of your application, please attach any materials necessary for consideration of this request, including: maps, drawings,
photographs, copies of regulations, statutes, rules, scientific data, expert/industry reports or standards, statistics, or any other
material that may aid in the consideration of your application. Please note further, that your appearance before the commission may
be necessary in order to consider your application. Send your application and supporting materials to:
New Jersey State Police Marine Services Bureau
P.O. Box
7068, West Trenton, NJ 08628-0068
D
ate o
f
A
pp
lication
App
licant Si
g
nature
CLEAR FORM
S.P. 660 (05/17) 2
DO NOT WRITE BELOW THIS LINE – FOR STATE POLICE USE ONLY
WAIVER: GRANTED DENIED
(Explain on back.)
DATE APPROVED
Waiver of ________________________ is hereby granted to: ____________________________________
Within the following conditions. ____________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
STARTING:
______________________________
ENDING:
________________________________
TIME:
_____________ Hours
TO:
_____________ Hours
BODY OF WATER: ___________________________________________________________________
New Jersey State Police Marine Services Bureau Chief’s Signature
WAIVE
R
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APPLICATION FOR WAIVER OF BOATING REGULATION (New Jersey State Police)

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Completed 29 July 2020

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