FIREWORKS PERMIT APPLICATION
FOR SELLING OR DISPLAYS
To the Clerk Fee: **
Village of Caledonia
**See the bottom of page 2 for prices
County of Racine Receipt No.
The undersigned hereby applies for a license to engage in the
business of selling fireworks. Fireworks means “anything manufactured,
processed or packaged for exploding, emitting sparks or combustion which
does not have another common use, but does not include any of the
following listed in Title 7 Chapter 6 Section 7-6-1 (a) (1-14)”:
Company Name:
Address of Sales or Display Location:
Term beginning: , 20 ending , 20
The applicant agrees to comply with and be bound by all the laws,
ordinances, rules, regulations and penalties governing the business for
which this license is applied for.
D.O.B.
(Print Name)
Phone No.
(Signature)
Dated:
(Home Address)
S.S. #
(City, State and Zip)
DL #
Subscribed and sworn to before me
this day of
20
Notary Public, Racine County, WI
My Commission Exp.:
(Over)
click to sign
signature
click to edit
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