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2. 
3. CIRCUS, CARNIVAL OR SHOW LICENSE APPLICATION
5. First Name*
6. Last Name*
8. Address*
10. City*
11. State*
12. Zip Code*
14. Phone Number*
15. Email Address
17. Date of Birth*
18. Place of Birth*
20. Driver's License #*
21. State*
23. Place the Event will take Place*
25. Date(s) of the Event*
27. Name of Owner(s)*
28. Insurance Carrier*
30. Number of Days, Multiplied by $50 per day*
32. Sideshow/Concession $10 each, Multiplied by Number of Days*
34. Signature*
35. Date*
39. City Manager Approval
40. Date
42. Police Approval
43. Date

45. INSPECTION: The premises will be inspected by the Chief of Police and Building Inspector just prior to the commencement of the event, to determine that the conduct of the event will be within regulations, but they shall not be required to certify the safety of any mechanical ride at any such carnival, show or circus.

47. Inspector Approval
48. Date
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50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field