Town of Chenango
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Application for Exhibition, Performance for Hire, Carnival, Circus,
Carrousel, Bazaar, Open-Air Show or Place of Amusement
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1.
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Name of the applicant.
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2.
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State whether an individual, partnership or corporation.
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3.
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If a partnership, state the names of all persons having an interest
in the business.
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4.
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If a corporation, state the names of its officers.
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5.
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If a corporation, give names of each stockholder, together with the
number of shares of capital stock held by each.
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6.
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Proposed location of the event.
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7.
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Nature of the entertainment, exhibition, etc. to be produced.
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8.
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A detailed account of each exhibition, entertainment, performance and/or
amusement device to be located on the proposed location of the event.
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9.
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State the number of lights to be used and the candlepower of each, all
pieces of equipment for music, loudspeaker devices and other devices for the
amplification of sound.
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10.
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State whether the applicant or anyone owning interest in the event has
been convicted of violating any ordinance or law pertaining to public morality
and decency.
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STATE OF NEW YORK
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COUNTY OF BROOME
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SS:
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, being duly sworn, deposes and says:
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I am,________________, above-named applicant, and make this
affidavit for the purpose of obtaining from the Town of Chenango a license
to conduct a __________________ as required by ordinance of the Town of Chenango,
regulating conduct of persons therein, defining offenses and providing penalties
for the violation thereof. I have personal knowledge of the matters stated
in the foregoing application and the statements therein contained are true.
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Sworn to before me this ___________ day of ___________ 20__.
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Notary Public
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