Request to use County Property

Van Buren County Administration
Request to use County Property
Your response and completed form will be automatically emailed to admin@vanburencountymi.gov. Please reach out to that address if you have any questions about the form or need help.
- CONTACT PERSON'S NAME
  
  First NameLast Name
- AGENCY
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- TELEPHONE NO.
  Format: (000) 000-0000.
- ALTERNATE TELEPHONE NO.
  Format: (000) 000-0000.
- EMAIL
  example@example.com
- NAME OF EVENT
- DESCRIPTION OF EVENT
- COUNTY PROPERTY REQUESTED (PLEASE LIST IF RESTROOM USE IS BEING REQUESTED FOR AN OUTDOOR EVENT)
- DATE(S) REQUESTED
  
  MonthDayYear
  Date
- TIME OF EVENT - START
- TIME OF EVENT - FINISH
- YESNO
- Proof of Event Insurance
  
  Cancelof
- ROOM REQUESTED
- IF CONF. ROOM - START / FINISH TIMES
- NUMBER OF ATTENDEES EXPECTED
- WILL YOU NEED AUDIO / VIDEO CAPABILITIES? PLEASE DESCRIBE
- - Permission is requested to use the specified County property. The responsible party agrees to restore the property to its original condition after use.
  - If event insurance is purchased, Van Buren County will be named as an additional insured. Whether or not insurance is purchased, the requesting party agrees to indemnify and hold Van Buren County harmless from any claims, actions, or liabilities arising from the use of County property.
  - I understand that no barricading of County facilities or parking areas is allowed and that emergency vehicles must have free access to all parking areas at all times. Additionally, I understand that County facilities may not be used for fundraising activities.
- Applicant's Signature*
- Date
  
  MonthDayYear
  Today's Date
- Should be Empty:

Van Buren County Administration

Request to use County Property