The undersigned hereby makes application for a license as indicated below:

Size: px
Start display at page:

Download "The undersigned hereby makes application for a license as indicated below:"

Transcription

1 BUSINESS LICENSE APPLICATION (Staff Use) Application received by: Date Received: Permit # : BL- Applicant Instructions/Guidelines: 1. Application: The following information (which includes the A. Business License Application, B. Information for the City of Columbia Emergency Disaster File, and C. Communications Emergency Contact List must be completed and submitted to the City Clerk s Office at Columbia City Hall. 2. Inspection of Business Location: After application has been received and reviewed by the appropriate staff at City Hall, inspections of the proposed business location will be scheduled with the applicant/representative. This process is to confirm the proposed location is meeting all code requirements regarding zoning, building, fire and electrical, as well as insuring sufficient parking for employees and customers will be provided. 3. Approved/Disapproved Business License: After all inspections have been completed, you will be contacted by the City Clerk s office and informed of the permit status. If a business license has been approved, the Clerk s Office will inform the applicant of the appropriate fees. 4. Approved Permit: The approved business license may be picked up at the City Clerk s Office upon receipt of fee payment. 5. How long will it take to receive a business license? If the business and proposed location meet all requirements, the license should be ready for the applicant to pick up from the City Clerk s Office within approximately five (5) working days. 6. Questions: If you have any questions or need help completing this application, please call the Columbia City Hall - Building Permit Office at (618) ext The undersigned hereby makes application for a license as indicated below: Applicant: Phone #: Applicant DOB: Driver s License #: Proposed Business Phone #: No. Street Zoning District: # of Employees: Full Time - Part Time -

2 Legal Owner of Proposed Business: Phone #: DOB: Driver s License #: Legal owner of proposed business property: Phone #: Contact person for building, electrical & fire inspections: Phone #: Type of Business (explain in detail): Number and type of coin operated devices (i.e.: games, food & cigarette vending machine, etc.) # Type: Illinois Business ID Tax #: Illinois kind of Business #: Applicant Signature (mandatory) Date Property Owner Signature (mandatory) Date (Do not write in this space - For office use only) Annual License Fee for Fiscal Year Beginning May 1 (Except as otherwise noted) TOTAL LICENSE FEE License due and payable at the: Office of the City Clerk 208 S. Rapp Avenue, P.O. Box 467 Columbia, IL May 1 Other City Clerk

3 INFORMATION FOR THE CITY OF COLUMBIA EMERGENCY DISASTER FILE Applicant: Business Phone #: ( ) The following information is being requested for the Emergency Disaster File of the City of Columbia: 1. Will your require more than: 20,000 gallons of water per month? 40,000 gallons of water per month? 60,000 gallons of water per month? 100,000 gallons of water per month? 2. Do you recycle any water? 3. Do you provide, serve or sell potable water to the public? (i.e. day care centers, restaurants, etc.) 4. Are you a medical office or dentist office? 5. Are you a legal office (Law or Title)? Thank you for your help. YES NO cc: Police Communications Office Public Works Department

4 February 1, 2004 Reference: Update Emergency Contact Person / Telephone Numbers Dear Business Owner: The Columbia Police Department Telecommunicators provide dispatch services for Police, Fire and Emergency Medical Services twenty-four hours a day, seven days a week for the City. In the evening and on weekends we make contact for the Public Works Department as problems arise in the City. We will assist Illinois Power, Harrisonville Telephone or other utilities as needed. During certain times it may be necessary to contact someone from your business related to the services we provide or on behalf of these other entities if a problem arises. That is the purpose of this letter. We would like to update our after hours contact list for your business. We have enclosed a form requesting information for the employees you would like contacted first in the event of an after hours alarm, fire, water system problem or other situation at your business. The form is enclosed with this letter. Please mail, fax, drop off or call and a police officer will pick up your contact form. If you have any questions, please call the Telecommunication center, (618) Thank you, Sergeant Jerald Paul Communications Supervisor Columbia Police Department JP

5 COLUMBIA POLICE DEPARTMENT COMMUNICATIONS EMERGENCY CONTACT LIST Business: Phone #: ( ) Fax #: AFTER HOURS CONTACT PERSON(S): FIRST CONTACT: SECOND CONTACT: THIRD CONTACT: FOURTH CONTACT: FIFTH CONTACT: Please list additional contacts on a separate piece of paper and attach.

6 Business License Application Check List: The following information has been completed and submitted to Columbia City Hall, Clerk s Office: - Business License Application (2 pages) Applicant & Property Owner signature mandatory. - Information for the City of Columbia Emergency Disaster File (1 page) - Columbia Police Department Communications Emergency Contact List (1 page) Application is reviewed by City of Columbia staff. Applicant/representative will be contacted by City of Columbia staff member to schedule inspections. Business license will be approved if all requirements are met and fee will be determined. City Clerk s office will inform applicant of approved or disapproved business license status. Approved business license may be picked up by applicant at the City Clerk s Office.

April 23, Dear Village of Lisle Business Owner:

April 23, Dear Village of Lisle Business Owner: April 23, 2018 Dear Village of Lisle Business Owner: It is time to renew your Village of Lisle Business Registration. The renewal fee is discounted to $25 if submitted on or before Friday, June 15, 2018.

More information

APPLICANT S AGENT RESOLUTION TO BEGIN THE DISASTER RECOVERY PROCESS WITH FEMA AND CAL-OES FOR THE JANUARY 2017 STORMS

APPLICANT S AGENT RESOLUTION TO BEGIN THE DISASTER RECOVERY PROCESS WITH FEMA AND CAL-OES FOR THE JANUARY 2017 STORMS STAFF REPORT MEETING DATE: April 4, 2017 TO: FROM: City Council Brian Cochran, Finance Manager 922 Machin Avenue Novato, CA 94945 415/ 899-8900 FAX 415/ 899-8213 www.novato.org SUBJECT: APPROVE A DESIGNATION

More information

CITY OF MADISON HEIGHTS OFFICE OF THE CITY CLERK BUSINESS LICENSE INITIAL APPLICATION

CITY OF MADISON HEIGHTS OFFICE OF THE CITY CLERK BUSINESS LICENSE INITIAL APPLICATION CITY OF MADISON HEIGHTS OFFICE OF THE CITY CLERK BUSINESS LICENSE INITIAL APPLICATION I (we) the undersigned do hereby apply and petition the City of Madison Heights to license the following business establishment.

More information

New Construction Grant Program

New Construction Grant Program New Construction Grant Program The Program is designed for new construction within city limits in City of Marshall. The incentive provides up to $1,000 for single family home. $500 per unit for a multifamily

More information

Liquor License Review Committee Application

Liquor License Review Committee Application Liquor License Review Committee Application Return Completed Application and Fees to: City Clerk s Office, 215 W. Main St. Northville, MI 48167 Cashier Validation (Code 15) APPLICANT INFORMATION Applicant

More information

THOMAS J. DART SHERIFF OF COOK COUNTY

THOMAS J. DART SHERIFF OF COOK COUNTY THOMAS J. DART SHERIFF OF COOK COUNTY MEMORANDUM TO: FROM: SUBJECT: All Sheriffs Department Personnel Sheriff Thomas J. Dart Cook County Sheriffs Annual Physical Fitness Test 2013 DATE: 11 OCT 13 Please

More information

Service Learning Project Fund Guidelines and Application. Applications due Oct. 15 for fall semester and Feb. 15 spring semester

Service Learning Project Fund Guidelines and Application. Applications due Oct. 15 for fall semester and Feb. 15 spring semester Service Learning Project Fund Guidelines and Application Applications due Oct. 15 for fall semester and Feb. 15 spring semester About Service learning project funds are to be used for the development of

More information

Local Business Tax Application 150 N. Lakeshore Drive Ocoee Florida Commercial Based Business

Local Business Tax Application 150 N. Lakeshore Drive Ocoee Florida Commercial Based Business Local Business Tax Application Commercial Based Business Required documents, please attach a copy of the following if applicable: Articles of INC/LLC and/or fictitious name certificate. www.sunbiz.org

More information

SMO: School Bus Accident Response/ Alternative Transport Vehicle

SMO: School Bus Accident Response/ Alternative Transport Vehicle OSF NORTHERN ILLINOIS EMERGENCY MEDICAL SERVICES STANDING MEDICAL ORDERS BLS, ILS, ALS SMO: School Bus Accident Response/ Alternative Transport Vehicle Overview: This policy was developed to assist in

More information

VILLAGE OF SOUTH ELGIN APPLICATION FOR LIQUOR LICENSE FOR INDIVIDUALS AND NON-INCORPORATED ENTITIES

VILLAGE OF SOUTH ELGIN APPLICATION FOR LIQUOR LICENSE FOR INDIVIDUALS AND NON-INCORPORATED ENTITIES VILLAGE OF SOUTH ELGIN APPLICATION FOR LIQUOR LICENSE FOR INDIVIDUALS AND NON-INCORPORATED ENTITIES To: Local Liquor Commissioner, Village of South Elgin Pursuant to the provisions of Title XI, Chapter

More information

James Berg, Chief of Police Oliver Collins, Acting Captain, Operations Division

James Berg, Chief of Police Oliver Collins, Acting Captain, Operations Division STAFF REPORT MEETING DATE: August 25, 2015 TO: FROM: City Council James Berg, Chief of Police Oliver Collins, Acting Captain, Operations Division 922 Machin Avenue Novato, CA 94945 (415) 899-8900 FAX (415)

More information

STANDARD OPERATING PROCEDURE 1

STANDARD OPERATING PROCEDURE 1 STANDARD OPERATING PROCEDURE 1 FOR IMPLEMENTATION of the UNIFORM ENVIRONMENTAL COVENANTS ACT LAND RECYCLING PROGRAM BUREAU OF ENVIRONMENTAL CLEANUP AND BROWNFIELDS MAY 2014 1 DISCLAIMER: Nothing in this

More information

GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2017 HOUSE BILL DRH30179-MG-50A (02/10)

GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2017 HOUSE BILL DRH30179-MG-50A (02/10) H GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 01 HOUSE BILL DRH01-MG-0A (0/) H.B. Mar, 01 HOUSE PRINCIPAL CLERK D Short Title: Raise Minimum Age to Access Tobacco Products. (Public) Sponsors: Referred to:

More information

FEMA Hazard Mitigation Grant Application for Seismic Retrofit of Live Oak Community Center

FEMA Hazard Mitigation Grant Application for Seismic Retrofit of Live Oak Community Center Page 1 of 7 14 Office of the City Manager CONSENT CALENDAR October 17, 2017 To: From: Honorable Mayor and Members of the City Council Dee Williams-Ridley, City Manager Submitted by: Scott Ferris, Director,

More information

2017 Summer Baseball 6 s & 7 s (co-ed), 8 s & 9 s (co-ed), s (boys)

2017 Summer Baseball 6 s & 7 s (co-ed), 8 s & 9 s (co-ed), s (boys) Department of Parks & Recreation Recreation Division 101 Field Point Road - Greenwich, CT 06836-2540 Phone: (203) 618-7649; Email: Recreation@greenwichct.org ACTIVITY NUMBER: 10403 2017 Summer Baseball

More information

Base Other Total Health Life Life Compensation Position Title Salary Wages Wages Insurance Insurance Insurance Package Sick Days Vac.

Base Other Total Health Life Life Compensation Position Title Salary Wages Wages Insurance Insurance Insurance Package Sick Days Vac. Village of Lake Zurich Budgeted Compensation For Full-Time Employees Fiscal Year 2018 $50,000 Basic Additonal Total Benefit Time to be Earned Administration Village Manager $ 162,302 $ 16,000 $ 178,302

More information

City of Lees Summit Department of Planning and Development Type 4 Special Event Fireworks Sales Application Form

City of Lees Summit Department of Planning and Development Type 4 Special Event Fireworks Sales Application Form 1. No more than twenty (20) licenses will be issued for the retail sale of fireworks to not for profit (NFP), religious or community service organizations only. Of the twenty (20) licenses, nineteen (19)

More information

Contaminated Sites Grant Program

Contaminated Sites Grant Program The Contaminated Sites Grant Program provides a grant of up to 100% of restoration costs for new developments on restored properties in the core areas (up to a maximum of $1,500.00 per new residential

More information

APPLICATION FOR BENEFITS LAW ENFORCEMENT OFFICERS AND FIRE FIGHTERS DISABILITY BENEFITS TRUST FUND

APPLICATION FOR BENEFITS LAW ENFORCEMENT OFFICERS AND FIRE FIGHTERS DISABILITY BENEFITS TRUST FUND EXHIBIT A M S Attorney General s Office Use Only: Application #: Receipt Date: G Approved G Disapproved Claim type: G Law Enforcement Officer G Fire Fighter STOP. Please read the fund policies and procedures

More information

Instruction. Return completed reimbursement application to:

Instruction. Return completed reimbursement application to: 4/4/2018 Instruction 1. Submit one copy per DOE Vendor ID / Tax ID. 2. Please list all OPT Codes on Page 1. 3. Page 5 must be notarized and in original signature. 4. Please mailed out all 19 pages of the

More information

The Corporation of the Town of Cobourg

The Corporation of the Town of Cobourg The Corporation of the Town of Cobourg Municipal Lottery Licensing ELIGIBILITY QUESTIONNAIRE Charitable gaming revenues are a source of funding for a large number of organizations. The Criminal Code of

More information

Faith Formation sessions begin the week of September 18 th, 2017

Faith Formation sessions begin the week of September 18 th, 2017 SAINT MAXIMILIAN KOLBE CATHOLIC CHURCH FAITH FORMATION REGISTRATION FORM Faith Formation sessions begin the week of September 18 th, 2017 To register in St. Maximilian Kolbe Faith Formation program the

More information

NOTICE OF A PUBLIC HEARING

NOTICE OF A PUBLIC HEARING NOTICE OF A PUBLIC HEARING This is a notice of the City s intent to raise water service fees. If you wish to protest this increase in fees, you must provide a written protest in accordance with instructions

More information

Yeap Transport Pte Ltd EtonHouse School Bus Transport Registration Form (Broadrick)

Yeap Transport Pte Ltd EtonHouse School Bus Transport Registration Form (Broadrick) Yeap Transport Pte Ltd EtonHouse School Bus Transport Registration Form (Broadrick) Family ID Parents Particulars Office Dad's Family Name Dad's Other Name Contact Nos MR DR Tel Job Position Company Name

More information

PLANNING BOARD APPLICATION

PLANNING BOARD APPLICATION ZONING TEXT AMENDMENT (Ord. Sec. 27-115) **Please read the entire packet for instructions prior to completing the application form** *Submit pages 1 thru 4 only, keep pages 5 thru 8 for your records *

More information

Attachment D School Readiness Provider Emergency Preparedness Plan

Attachment D School Readiness Provider Emergency Preparedness Plan Attachment D School Readiness Provider Emergency Preparedness Plan School Readiness Provider Physical Address Telephone Number SIGNATURE: DATE: NAME: TITLE: Child Care Facility or Home Name of facility

More information

Bright Horizons Back-up Child Care Registration Materials

Bright Horizons Back-up Child Care Registration Materials Registration Materials Dear Parent, Enclosed please find registration materials for Bright Horizons back-up child care centers. The information requested in these forms is required by Bright Horizons Back-up

More information

Tax Abatement Urban Revitalization Program Application Packet

Tax Abatement Urban Revitalization Program Application Packet Tax Abatement Application Packet This application packet is for applying for Tax Abatement for improvements made to properties within an Urban Revitalization Area established by the City Council. The City

More information

SPECIAL EVENT POLICY

SPECIAL EVENT POLICY CITY OF BATAVIA SPECIAL EVENT POLICY (DRAFT as of 9/30/13) I. POLICY STATEMENT The City recognizes that special events often bring certain benefits to the community. At the same time, the City must have

More information

TO: Crafters. SUBJECT: Christkindlesmarkt 2018 Holiday Craft Show

TO: Crafters. SUBJECT: Christkindlesmarkt 2018 Holiday Craft Show DEPARTMENT OF THE ARMY FAMILY AND MORALE, WELFARE AND RECREATION DIRECTORATE, US ARMY GARRISON, CARLISLE BARRACKS 46 ASHBURN AVENUE CARLISLE, PENNSYLVANIA 17013-5042 TO: Crafters SUBJECT: 2018 Holiday

More information

PATIENT INFORMATION Please Print

PATIENT INFORMATION Please Print PATIENT INFORMATION Please Print DATE Patient s Last Name First Name Middle Name Suffix Gender: q Male q Female Social Security Number of Birth Race Ethnic Group: q Hispanic q Non-Hispanic q Unknown Preferred

More information

CITY OF TUSCALOOSA, ALABAMA JOB CLASSIFICATION LIST PAY GRADE ORDER

CITY OF TUSCALOOSA, ALABAMA JOB CLASSIFICATION LIST PAY GRADE ORDER 3 $27,461.87 $36,440.50 0060 Security Guard N 4 $28,798.93 $38,214.79 0051 Building & Grounds Maintenance Worker N 0050 Custodial Worker N 9025 Sanitation Worker N 5 $30,136.32 $39,989.07 0070 Crew Worker

More information

CITY OF TUSCALOOSA, ALABAMA JOB CLASSIFICATION LIST ALPHABETICAL ORDER

CITY OF TUSCALOOSA, ALABAMA JOB CLASSIFICATION LIST ALPHABETICAL ORDER 5003 311 Call Center Manager 26 $58,214.98 $77,248.18 E 5004 311 Call Center Representative 7 $32,810.40 $43,537.61 N 5005 311 Call Center Representative, Senior 9 $35,484.50 $47,086.17 N 1013 Accountant

More information

Champaign-Urbana, Illinois

Champaign-Urbana, Illinois PresentS 2018 Health & Fitness Expo Thursday, April 26, 2018 4:00 p.m. 8:00 p.m. Friday, April 27, 2018 10:00 a.m. 7:00 p.m. Activities and Recreation Center, University of Illinois Campus Sponsored by

More information

DES PLAINES POLICE DEPARTMENT GENERAL ORDER Jim Prandini, Chief of Police

DES PLAINES POLICE DEPARTMENT GENERAL ORDER Jim Prandini, Chief of Police DES PLAINES POLICE DEPARTMENT GENERAL ORDER Jim Prandini, Chief of Police SUBJECT: CITIZENS ON PATROL NUMBER: 1.26 SECTION: 1 ORGANIZATION & MISSION EFFECTIVE: March 24, 2006 AMENDED: RESCINDS: Index Topic

More information

2017 Telethon Volunteer Campaign Special Event Guidelines

2017 Telethon Volunteer Campaign Special Event Guidelines 2017 Telethon Volunteer Campaign Special Event Guidelines Thank you very much for being a Volunteer! Before you Plan a Special Event assess the 75/25% Revenue Expense Rule If your special event expenses

More information

APPLICATION FOR HEALTH PROFESSIONAL LICENSURE

APPLICATION FOR HEALTH PROFESSIONAL LICENSURE APPLICATION FOR HEALTH PROFESSIONAL LICENSURE Passport Size Photograph Please complete this application on the computer then print and sign. Hand-written applications will not be accepted. Section 1: Application

More information

Please return the completed application to me at the address shown below or .

Please return the completed application to me at the address shown below or  . Dear Student, Thank you for your interest in becoming a volunteer at Concord Hospital. We believe we can offer you a meaningful experience you will find personally rewarding, while contributing to your

More information

March 3, Dear Team Captain,

March 3, Dear Team Captain, March 3, 2008 Dear Team Captain, Welcome to the 17 th annual 24 Hour Relay Challenge scheduled for Memorial Day weekend, May 24-25, 2008, on Holt Field at San Luis Obispo High School. This packet is intended

More information

Junior Baseball Spring 2017 Ages 8 & 9

Junior Baseball Spring 2017 Ages 8 & 9 ACTIVITY NUMBER: 10402 Department of Parks & Recreation Recreation Division 101 Field Point Road - Greenwich, CT 06836-2540 Phone: (203) 618-7649 Email: Recreation@greenwichct.org Junior Baseball Spring

More information

Town of Madison Beach and Recreation Department After/Before School Program 8 Campus Drive Madison, CT Phone: (203) /Fax: (203)

Town of Madison Beach and Recreation Department After/Before School Program 8 Campus Drive Madison, CT Phone: (203) /Fax: (203) Per Connecticut General Statute 19a-77 we are required to disclose that our programs are not licensed by the State Office of Early Childhood. Dear Parent: To enroll your child(ren) in the, please complete

More information

Volume 8, Issue 2 June June 6, 2012

Volume 8, Issue 2 June June 6, 2012 Courier Volume 8, Issue 2 June 2012 Dear Tuskegeeans & Friends, June 6, 2012 On behalf of the Los Angeles Tuskegee Alumni Club, we solicit your support for our upcoming Scholarship Fund Raising Event.

More information

Small Business Resource Guide for Monroe County, Ohio

Small Business Resource Guide for Monroe County, Ohio Small Business Resource Guide for Monroe County, Ohio Published by: The Ohio Small Business Development Center at Marietta 308 Front Street Marietta, OH 45750 740-373-5150 sbdc@wscc.edu The Ohio SBDC at

More information

Navasota Economic Development Corporation

Navasota Economic Development Corporation Navasota Economic Development Corporation Business Improvement Grant Program 200 E. McAlpine P. 936-825-6475 P.O. Box NAVASOTA 910 ECONOMIC DEVELOPMENT CORPORATION BUSINESS IMPROVEMENT GRANT PROGRAM F.

More information

OFFICE OF MEMBERSHIP COMMITTEE

OFFICE OF MEMBERSHIP COMMITTEE Dear Prospective Member, Thank you for your interest in becoming a member of the Mohegan Volunteer Fire Association (MVFA). Few jobs offer you the opportunity to save a life, but as a volunteer firefighter

More information

FOOD VENDOR APPLICATION. Brunsco Spring fling Shallotte, NC May 4 th, 5 th and 6 th, 2018

FOOD VENDOR APPLICATION. Brunsco Spring fling Shallotte, NC May 4 th, 5 th and 6 th, 2018 FOOD VENDOR APPLICATION Brunsco Spring fling Shallotte, NC May 4 th, 5 th and 6 th, 2018 Company Name: Representative Name: Phone: Email: Street Address: City: State: Zip: Tax ID# Event Location: 349 Whiteville

More information

June 1, 2, and 3, 2018 $25 per person

June 1, 2, and 3, 2018 $25 per person T he Greater Pittsburgh Chapter of the Oncology Nursing Society is a local organization dedicated to promoting quality health care for people living with cancer. In 1994, the chapter inaugurated its first

More information

THE ROTARY FOUNDATION of Rotary International 1560 Sherman Avenue Evanston, IL USA

THE ROTARY FOUNDATION of Rotary International 1560 Sherman Avenue Evanston, IL USA THE ROTARY FOUNDATION of Rotary International Evanston, IL 60201-3698 USA 28 March 2006 Host Cosponsor Steve Achard, Project Contact Rotary Club of Fallbrook Village (D - 5340) 304 Shady Glen Drive Fallbrook,

More information

City of Hudson Department of Fire 520 Warren Street Hudson, New York 12534

City of Hudson Department of Fire 520 Warren Street Hudson, New York 12534 City of Hudson Department of Fire 520 Warren Street Hudson, New York 12534 Standard Operating Procedure Membership Application Process Revised January 15, 2014 The intent of this procedure is to insure

More information

Legislative Administration Office Only. Last First Middle Are you known by other names while previously employed? YES NO.

Legislative Administration Office Only. Last First Middle Are you known by other names while previously employed? YES NO. Tohono O odham Nation Legislative Branch P.O. Box 837 Sells, Arizona 85634 Phone: (520) 383-2470 (520) 383-5260 Fax: (520) 383-2479 Website: www.tolc-nsn.org Legislative Administration Office Only Date

More information

Green Building Incentive Program Guidelines & Procedures

Green Building Incentive Program Guidelines & Procedures Green Building Incentive Program Guidelines & Procedures A program of Andersonville Special Service Area #22 Administered by Andersonville Development Corporation 5153 N. Clark St., Suite 204 Chicago,

More information

Small Business Assistance Program Guidelines

Small Business Assistance Program Guidelines Small Business Assistance Program Guidelines I. PROGRAM OVERVIEW The Small Business Assistance Program ( Program ) is an endeavor of the City of Dublin to assist Dublin-based businesses with the cost of

More information

If you decide to enter the Mr. /Ms. Alumni Contest, please find the attachments regarding:

If you decide to enter the Mr. /Ms. Alumni Contest, please find the attachments regarding: January 20, 2018 Dear NCCU Alums, The Mr. and Mrs. Alumni Contest for the Fiscal Year 2018-2019 has officially begun. This year Homecoming is scheduled for November 3, 2018. A new structure for the contest

More information

Grand Lodge of Michigan Bikes for Books Program

Grand Lodge of Michigan Bikes for Books Program Grand Lodge of Michigan Bikes for Books Program Goals: - To increase visibility of the local Masonic Lodge in our communities. - To support public education and assist in the education of our children.

More information

Eric J. Fritsch, Ph.D. University of North Texas, Department of Criminal Justice and Middleton PD Staff

Eric J. Fritsch, Ph.D. University of North Texas, Department of Criminal Justice and Middleton PD Staff Eric J. Fritsch, Ph.D. University of North Texas, Department of Criminal Justice and Middleton PD Staff Ensures that there will be sufficient levels of staffing to address future crime and disorder issues

More information

TELECOMMUTING AGREEMENT

TELECOMMUTING AGREEMENT TELECOMMUTING AGREEMENT This Telecommuting Agreement exists in accordance with the UAB/UAB Medicine Telecommuting Guidelines. This Telecommuting Agreement specifies the conditions applicable to an arrangement

More information

PASADENA YMCA 2014 Winter Basketball Registration Form

PASADENA YMCA 2014 Winter Basketball Registration Form PASADENA YMCA 2014 Winter Basketball Registration Form Child s Name: Date of Birth: Sex: M F Address City Zip School Height Age Grade Mother s Name Daytime Phone Father s Name Daytime Phone Signature:

More information

Rockton Fire Protection District. Application for Membership

Rockton Fire Protection District. Application for Membership Rockton Fire Protection District Application for Membership 1 Rockton Fire Protection District Mission Statement The Rockton Fire Protection District is dedicated to protecting the lives and property of

More information

CITY OF BROCKVILLE APPLICATION FOR SITE PLAN CONTROL Residential Development

CITY OF BROCKVILLE APPLICATION FOR SITE PLAN CONTROL Residential Development CITY OF BROCKVILLE APPLICATION FOR SITE PLAN CONTROL Residential Development TO BE COMPLETED BY THE PLANNING DEPARTMENT: Date Submitted: Date Complete: Fee Rec'd: File No.: 1.0 Owner Information Name of

More information

COMMERCIAL BUSINESS LICENSE APPLICATION

COMMERCIAL BUSINESS LICENSE APPLICATION COMMUNITY DEVELOPMENT COMMERCIAL BUSINESS LICENSE APPLICATION 20 North Main Street, P.O. Box 1005 Brigham City, Utah 84302 Phone 435-734-6617 Fax 435-723-8132 GENERAL LICENSE INFORMATION AND CONTACT LIST

More information

2018 DETROIT GRAND PRIX ASSOCIATION Renewal Membership Application

2018 DETROIT GRAND PRIX ASSOCIATION Renewal Membership Application 2018 DETROIT GRAND PRIX ASSOCIATION Renewal Membership Application Do not send payment without completed application. All DGPA members must be at least 18 yrs of age or 16 yrs old if accompanied by adult

More information

MT. WASHINGTON FIRE PROTECTION DISTRICT 772 NORTH BARDSTOWN ROAD MT. WASHINGTON, KY

MT. WASHINGTON FIRE PROTECTION DISTRICT 772 NORTH BARDSTOWN ROAD MT. WASHINGTON, KY MT. WASHINGTON FIRE PROTECTION DISTRICT 772 NORTH BARDSTOWN ROAD MT. WASHINGTON, KY 40047 502-538-4222 (PRINT OR TYPE IN BLUE OR BLACK INK) APPLICATION FOR MEMBERSHIP : DRIVER S LICENSE NO. LAST FIRST

More information

GUIDELINES FOR BUSINESS IMPROVEMENT GRANT PROGRAM BY THE COLUMBUS COMMUNITY & INDUSTRIAL DEVELOPMENT CORPORATION

GUIDELINES FOR BUSINESS IMPROVEMENT GRANT PROGRAM BY THE COLUMBUS COMMUNITY & INDUSTRIAL DEVELOPMENT CORPORATION GUIDELINES FOR BUSINESS IMPROVEMENT GRANT PROGRAM BY THE COLUMBUS COMMUNITY & INDUSTRIAL DEVELOPMENT CORPORATION Section 1. Purpose. The purpose of this program is to promote the development and expansion

More information

IOS - Recruitment and Testing Services

IOS - Recruitment and Testing Services Westchester Police Department Application Instructions Thank you for your interest in the Westchester Police Department. Please be sure to carefully review all application instructions and testing information.

More information

PENSACOLA STATE COLLEGE HUMAN RESOURCES OFFICE VOLUNTEER PACKET

PENSACOLA STATE COLLEGE HUMAN RESOURCES OFFICE VOLUNTEER PACKET HUMAN RESOURCES OFFICE VOLUNTEER PACKET Volunteer Name Student ID Number Department Department Supervisor Note: Only completed packets for volunteers should be sent to Human Resources. Revised 10/20/2015

More information

Rhode Island Department of Health Application and Instructions for Food Business:

Rhode Island Department of Health Application and Instructions for Food Business: RI Department of Health www.health.ri.gov Revised 06/09/2015 Rhode Island Department of Health Application and Instructions for Food Business: Market (n-profit) Name of Business Previous Business Name

More information

Glastonbury YMCA 29 Welles Street, Glastonbury CT Dear YMCA Family,

Glastonbury YMCA 29 Welles Street, Glastonbury CT Dear YMCA Family, s Dear YMCA Family, Thank you for choosing the Glastonbury Family YMCA Preschool for your early childhood child care needs. We are excited to welcome you and your family to our program! The Y s focus is

More information

Delaware National Guard 2018 LOTTERY

Delaware National Guard 2018 LOTTERY Delaware National Guard 2018 LOTTERY FOR THE USE OF THE BETHANY BEACH TRAINING SITE BETHANY BEACH TRAINING SITE BILLETING OFFICE, BLDG. 114 163 SCANNELL BOULEVARD BETHANY BEACH, DE 19930-9770 Live updates

More information

Eligibility Eligibility is restricted to private sector organizations operating in Nunavut as defined in the Inuit Language Protection Act.

Eligibility Eligibility is restricted to private sector organizations operating in Nunavut as defined in the Inuit Language Protection Act. APPLICATION FOR ASSISTANCE GRANTS & CONTRIBUTIONS PROGRAMS APPLICATION FORM FOR: INSTRUCTIONS 1. Application deadline: Open all year. 2. Please print or type when completing this form. 3. Attach a separate

More information

Maryland Commercial Air Ambulance Services

Maryland Commercial Air Ambulance Services State of Maryland Maryland Institute for Emergency Medical Services Systems 653 West Pratt Street Baltimore, Maryland 21201-1536 Lawrence J. Hogan, Jr. Governor Donald L. DeVries, Jr., Esq. Chairman Emergency

More information

Commercial Water & Sewer Impact Fee Assistance

Commercial Water & Sewer Impact Fee Assistance Commercial Water & Sewer Impact Fee Assistance Introduction This program has been created to encourage new business in the downtown area. The program is meant to diversify the business mix, expand the

More information

PAUL HARRIS SOCIETY FREQUENTLY ASKED QUESTIONS

PAUL HARRIS SOCIETY FREQUENTLY ASKED QUESTIONS ENGLISH (EN) PAUL HARRIS SOCIETY FREQUENTLY ASKED QUESTIONS WHAT IS THE PAUL HARRIS SOCIETY? The Paul Harris Society recognizes Rotary members and friends of The Rotary Foundation who contribute $1,000

More information

Defines adult foster care and license categories Defines licensee

Defines adult foster care and license categories Defines licensee 1 PURPOSE LEGAL BASE Act 218 Adult Foster Care This Manual establishes the policy and procedures to be followed by regulatory staff when the licensee requests a change in the terms or modification of a

More information

DEFINITIONS. Subpart 1. Scope. As used in this chapter, the following terms have the meanings given them in this part.

DEFINITIONS. Subpart 1. Scope. As used in this chapter, the following terms have the meanings given them in this part. Minnesota WIC Rules: Chapter 4617 of Minnesota Rules Includes amendments effective December 7, 2009 4617.0002 DEFINITIONS. Subpart 1. Scope. As used in this chapter, the following terms have the meanings

More information

State of California Health and Human Services Agency Department of Health Care Services

State of California Health and Human Services Agency Department of Health Care Services TOBY DOUGLAS DIRECTOR EDMUND G. BROWN JR. GOVERNOR Dear Applicant: Thank you for your recent inquiry regarding participation in the Medi-Cal program. Please complete the enclosed Medi-Cal provider enrollment

More information

Application. Contact Information: Mailing Address (Address, City, State, Zip) Activity Details

Application. Contact Information: Mailing Address (Address, City, State, Zip) Activity Details Application Please complete application and submit to the Reliv Kalogris Foundation (RKF) for approval. Before considering a Network to Nourish event, remember that no costs or expenses will be reimbursed

More information

The National Black College Alumni Hall of Fame Foundation, Inc. Scholarship Application

The National Black College Alumni Hall of Fame Foundation, Inc. Scholarship Application The National Black College Alumni Hall of Fame Foundation, Inc. Scholarship Application Our ancestors struggled for the opportunity to have an education. Now we have to dedicate our efforts to the growth

More information

The theme for this year s Golowan Festival is: Golowan Goes Wild About All Creatures Great and Small

The theme for this year s Golowan Festival is: Golowan Goes Wild About All Creatures Great and Small Golowan Festival Dates 2018 Mazey Day Saturday 23 rd June 2018 Quay Fair Day Sunday 24 th June 2018 STALLS INFORMATION AND APPLICATION FORM PLEASE READ CAREFULLY Welcome to the final weekend of the Golowan

More information

Springfield Police Department CITIZEN RIDE-ALONG PROGRAM

Springfield Police Department CITIZEN RIDE-ALONG PROGRAM Springfield Police Department CITIZEN RIDE-ALONG PROGRAM Ever been curious what it s like to be a police officer? Here s your chance! The Springfield Police Department s ride-along program gives eligible

More information

BUSINESS ASSISTANCE PROGRAM APPLICATION CHECKLIST

BUSINESS ASSISTANCE PROGRAM APPLICATION CHECKLIST BUSINESS ASSISTANCE PROGRAM APPLICATION CHECKLIST All items on the checklist are required to submit your application. Incomplete applications cannot be accepted. Original Application (General Information,

More information

2017 Fall Field Hockey Co-ed, Grades 1-8

2017 Fall Field Hockey Co-ed, Grades 1-8 ACTIVITY NUMBER: 30601 Department of Parks & Recreation Recreation Division 101 Field Point Road - Greenwich, CT 06836-2540 Phone: (203) 618-7649; Email: Recreation@greenwichct.org 2017 Fall Field Hockey

More information

2018 Municipal Election Vote By Mail

2018 Municipal Election Vote By Mail 2018 Municipal Election Vote By Mail For Immediate Release, September 7, 2018 For the upcoming 2018 Municipal Election, residents within the Town of Erin will be casting their votes to elect their Municipal

More information

Kiwanis Club of Aiken P.O. BOX 991 AIKEN, SC 29802

Kiwanis Club of Aiken P.O. BOX 991 AIKEN, SC 29802 Aiken s Bacon and Brews Dear Friends of Kiwanis, On March 16 th 2018, the Kiwanis Club of Aiken will present the First Annual Aiken s Bacon & Brews fundraiser. This fundraiser will benefit local children

More information

O H I O P U B L I C W O R K S C O M M I S S I O N P R O J E C T G R A N T A G R E E M E N T

O H I O P U B L I C W O R K S C O M M I S S I O N P R O J E C T G R A N T A G R E E M E N T O H I O P U B L I C W O R K S C O M M I S S I O N P R O J E C T G R A N T A G R E E M E N T S T A T E C A P I T A L I M P R O V E M E N T P R O G R A M Pursuant to Ohio Revised Code 164.05 and Ohio Administrative

More information

Manufacturer Job Creation and Investment Program

Manufacturer Job Creation and Investment Program CITY OF CRYSTAL LAKE Manufacturer Job Creation and Investment Program GRANT APPLICATION FORM ADMINISTERED BY: CITY OF CRYSTAL LAKE PLANNING & ECONOMIC DEVELOPMENT 100 W. WOODSTOCK STREET CRYSTAL LAKE,

More information

***BE SURE TO REVIEW BOTH FRONT AND BACK OF PACKET***

***BE SURE TO REVIEW BOTH FRONT AND BACK OF PACKET*** Capital Digestive Care, LLC Ambulatory Endoscopy Center of Maryland A Division of AmSurg Corporation CapitalDigestiveCare.com/mdd Dear Patient: Thank you for inquiring about scheduling a colonoscopy with

More information

Application form for Commissioning Generation Facility Registration by a Market Participant. including explanatory notes

Application form for Commissioning Generation Facility Registration by a Market Participant. including explanatory notes Application form for Commissioning Generation Facility Registration by a Market Participant including explanatory notes IMPORTANT: Please read this carefully before completing this form. Italicised words

More information

DeKalb County Sheriff's Office CIVIL PROCESS COMMUNICATION CENTER CORRECTIONS/JAIL

DeKalb County Sheriff's Office CIVIL PROCESS COMMUNICATION CENTER CORRECTIONS/JAIL ADMINISTRATION OFFICE 815-895-7260 DeKalb County Sheriff's Office CIVIL PROCESS 815-895-7259 COMMUNICATION CENTER 815-895-2155 CORRECTIONS/JAIL 815-895-4177 FAX 815-895-7235 - SHERIFF FAX 815-895-7275

More information

Name Nickname. DOB Age Sex. Address. City State Zip. Name Relationship. Address. City State Zip. Phone (Day) (Evening)

Name Nickname. DOB Age Sex. Address. City State Zip. Name Relationship. Address. City State Zip. Phone (Day) (Evening) A REGGIO-INSPIRED SCHOOL 4401 Lancaster Pike - Bldg. 27 Wilmington DE 19805 www.ithakaelc.org Phone: (302) 689-3832 Fax: (888) 316-8303 info@ithakaelc.org Enrollment Application Child Information Name

More information

YMCA OF MIDDLE TENNESSEE AUTHORIZATION AND RELEASE FOR THE PROCUREMENT OF A CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT

YMCA OF MIDDLE TENNESSEE AUTHORIZATION AND RELEASE FOR THE PROCUREMENT OF A CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT YMCA OF MIDDLE TENNESSEE AUTHORIZATION AND RELEASE FOR THE PROCUREMENT OF A CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT *This information will be used for verification and identification purposes only

More information

REBATE PROGRAM APPLICATION

REBATE PROGRAM APPLICATION REBATE PROGRAM APPLICATION Instructions: Completely fill out the application and submit to Sacramento Suburban Water District. 1. Name and Address 2. Application Date: Applicant Name (Rebate Check/Credit

More information

Business Enhancement Grant Application

Business Enhancement Grant Application Business Enhancement Grant Application Applicant Information Business Name Contact Person Property Fax Type of Business Term of Lease (if applicant is not the Owner) Property Owner Information Name Street

More information

SF SEED Application Supplemental Forms

SF SEED Application Supplemental Forms SF SEED Application Supplemental Forms Thank you for applying for the SF SEED Spring 2018 Stipend! The following forms are due on April 21st, 2018 Before turning in your forms, please read the following

More information

COUNTY OF SACRAMENTO Probation Department 3201 FLORIN-PERKINS ROAD, SACRAMENTO, CALIFORNIA TELEPHONE (916) FAX (916)

COUNTY OF SACRAMENTO Probation Department 3201 FLORIN-PERKINS ROAD, SACRAMENTO, CALIFORNIA TELEPHONE (916) FAX (916) RULES AND REGULATIONS The Ride-Along Program offers members of the public the opportunity to interact with officers from our Department. The program seeks to increase public awareness regarding the functions

More information

Applicant s Name including degrees: Mentor(s) Name(s) including degrees: Research Institution: Project Title:

Applicant s Name including degrees: Mentor(s) Name(s) including degrees: Research Institution: Project Title: UROLOGY CARE FOUNDATION 2018 RISING STARS IN UROLOGY RESEARCH AWARD PROGRAM APPLICATION AGREEMENT FORM Your application for the Urology Care Foundation Rising Stars in Urology Research Award will not be

More information

REQUEST FOR PROPOSAL CNC Lathe Machine INSTRUCTIONS TO BIDDERS

REQUEST FOR PROPOSAL CNC Lathe Machine INSTRUCTIONS TO BIDDERS REQUEST FOR PROPOSAL CNC Lathe Machine INSTRUCTIONS TO BIDDERS 1. INTRODUCTION - Van Dyke Public Schools is requesting proposals for the purchase of a CNC Lathe Machine to be used in our Career & Technical

More information

BUSINESS CENTER APPLICATION

BUSINESS CENTER APPLICATION CENTER FOR ENTREPRENEURSHIP AND ECONOMIC DEVELOPMENT TSU INCUBATION CENTER-MEMBER APPLICATION COMPANY INFORMATION BUSINESS CENTER APPLICATION Business Name: FEIN Business Phone Number: Current Business

More information

Joint Committee on Volunteer Permits EMERGENCY SERVICE VOLUNTEER WARNING LIGHT PERMIT APPLICATION PACKAGE

Joint Committee on Volunteer Permits EMERGENCY SERVICE VOLUNTEER WARNING LIGHT PERMIT APPLICATION PACKAGE Joint Committee on Volunteer Permits EMERGENCY SERVICE VOLUNTEER WARNING LIGHT PERMIT APPLICATION PACKAGE Rhode Island General Law 31-23- 11.1 requires that the use and installation of red and white flashing

More information

REQUEST FOR PROPOSAL FOR BUILDING LEASE

REQUEST FOR PROPOSAL FOR BUILDING LEASE REQUEST FOR PROPOSAL FOR BUILDING LEASE Notice is hereby given that the City of Carroll, will accept written proposals until Monday, October 2, 2017 at 1:00 pm. Proposals are to be sent or delivered to

More information

THE 3905 CENTURY CLUB, INC. SHORTWAVE LISTENER AWARD APPLICATION (EACH BAND/MODE SEPARATELY) (NOT ENDORSABLE)

THE 3905 CENTURY CLUB, INC. SHORTWAVE LISTENER AWARD APPLICATION (EACH BAND/MODE SEPARATELY) (NOT ENDORSABLE) THE 3905 CENTURY CLUB, INC. SHORTWAVE LISTENER AWARD APPLICATION (EACH BAND/MODE SEPARATELY) (NOT ENDORSABLE) The SWL Award is earned by submitting QSL cards confirming monitored contacts made between

More information