OFFICE OF THE TOWN CLERK
KATE MURRAY
Town Clerk
One Washington Street Hempstead, NY 11550
Tel: (516) 812-3025 email: licensing@tohmail.org
DONALD X. CLAVIN JR.
Supervisor
BLOCK PARTY APPLICATION
Please Print Clearly - Answer all questions
APPLICANT’S SIGNATURE
Rev. 1/20
Appl #:
Date:
Map Ref. #
Applicant’s Name:
Phone #
Applicant’s Address:
Applicant’s Email address:
Town:
Rain Date:
LOCATION WHERE EVENT WILL BE HELD:
4. Date of Event:
AM *PM
5. Time of Event:
1. Notify and obtain signatures of ALL residents who live on the street, a majority of which must approve.
2. Obtain permission of local fire district AND permission of local police precinct.
3. Supply own street barricades, safety cones or caution tape. You may contact our
Town of Hempstead’s Department of Highway at (516) 812-3471 for barricades.
4. FIREWORKS OF ANY KIND ARE PROHIBITED.
5. Bicycle riding is prohibited within the confines of the block party.
6. Application must be received in this office at least TWENTY (20) DAYS PRIOR TO BLOCK PARTY.
7. The roadway must have a lane free of obstruction, to allow emergency vehicles access to entire street.
8. Person signing this document is responsible for ensuring that the above conditions are fulfilled.
BETWEEN
STREETS
POLICE DEPT. APPROVAL
/ /
* APPLICANT GUIDELINES *
* Must end by 11pm
BADGE #
DATE PRECINCT #
FIRE DEPT. APPROVAL
/ /
DATE
Office Use Only
PLEASE OBTAIN POLICE AND FIRE APPROVAL SIGNATURES
PRIOR TO SUBMITTING TO THE TOWN OF HEMPSTEAD
Rev. 1/20
Signature of every resident on the street to be closed
must be obtained whether in favor or opposed.
Total number of homes on street to be closed number of homes
I herby certify that the above signatures are those of every resident on the street (s) to be closed.
If a resident is known to be out of town, please indicate on signature line above.
Attach additional signature pages if necessary.
ALL RESIDENTS MUST BE NOTIFIED OF THE BLOCK PARTY
APPLICANT’S SIGNATURE
IN FAVOR OPPOSED OTHER
ADDRESSSIGNATURE
1. Yes
No
2. Yes
No
3. Yes
No
4. Yes
No
5. Yes
No
6. Yes
No
7. Yes
No
8. Yes
No
9. Yes
No
10. Yes
No
11. Yes
No
12. Yes
No
13. Yes
No
14. Yes
No
15. Yes
No
16. Yes
No
17. Yes
No
18. Yes
No
19. Yes
No
20. Yes
No
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