Permit to Process and Display Fireworks
County
City
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Application having been made in accordance with the laws of the State of:
This permit is issued to:
Approved Date to display fireworks:
Approved Time to display fireworks:
Approved Location to display fireworks:
Approved Event to display fireworks:
Signature of officer issuing permit
FOUNDEY
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Should be Empty: