55 Main Street, PO Box 660, Sag Harbor, NY 11963 (631)725-0222
FOOD SALE/RAFFLE TICKET APPLICATION
ORGANIZATION CONDUCTING SALE_______________________________________________________
PERSON IN CHARGE OF SALE______________________________________________________________
PURPOSE OF SALE________________________________________________________________________
DATE OF SALE____________________________________________________________________________
TYPE OF SALE: _____________________FOOD___________________RAFFLE
LOCATION OF SALE_______________________________________________________________________
NAME OF PROPERTY OWNER______________________________________________________________
PROPERTY OWNER’S APPROVAL___________________________________________________________
(signature)
I DO HEARBY SWEAR THAT ALL STATEMENTS CONTAINED IN THIS APPLICATION ARE TRUE
TO THE BEST OF MY KNOWLEDGE.
APPLICANT_____________________________________________DATE____________________________
PERMIT
ISSUED TO_______________________________________________________________________________
DATE OF SALE____________________________________________________________________________
DATE OF ISSUE___________________________________________________________________________
ISSUED BY_______________________________________________________________________________