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CITY FORMS/APPLICATIONS

CITY FORMS AND APPLICAITONS

***The City of Palmyra may contact you for more information needed and for signatures prior to approving applications.

sPECIAL EVENT PERMIT APPLICATION

Applicant Name:

Applicant Email:

Company/Org.

City:

State:

Phone:

Event Organizer

Event Organizer Name (if hired/other):

Event Organizer Email (if hired/other):

Event Organizer Phone (if hired/other):

Best Phone to Contact DURING Event:

Title of Event:

Event Dates:

Event Location:

Event Times:

Event Insurance Company:

Do you need streets closed for this event?

YES

Attached a copy of the map for the event location/routes. Note Start to Finish if route is involved. Note any streets involved. Note any important locations for police/fire/medical/FEMA if needed.

Upload File

Any additional information relating to the event:

Free Text

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Thank you for contacting us.
We will get back to you as soon as possible.

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Prefer to print and deliver/mail your Special Event Permit application? Click the button below to print/download.

DOWNLOAD PRINT SPECIAL EVENT PERMIT

APPLICATION FOR UTILITY SERVICE

Last Name:

First Name:

Middle Initial

Date of Birth:

Phone:

Marital Status:

Address utility is needed:

Home Status:

Rent

Own

Date Needed:

Landlord (if applicable):

# of people 18 & older living in home:

Billing address if different from above:

Do you currently have or have had service in the City of Palmyra?

YES

If yes, what address?

If yes, under what name?

Do you own a dog?

YES

If yes, what is the breed of the dog?

Name/relationship/address/phone of adult not living with you:

Employer Information - Name/Address/Phone

Joint Applicant (if applicable): Full Name/Birth Date/Phone/Employer

Has the Joint Applicant have or previously have service in the City of Palmyra?

YES

If yes, what address and name?

Customer as used herein, shall be deemed to include all residents of a dwelling of legal age, whether married or unmarried, except full-time students residing with a parent or parents; and all persons possessing any ownership interest whatsoever in a business. All customers will be required to contract with the city for utilities and shall be liable for payment. The undersigned agrees that he or she is responsible for payment of utility service at the address requested above and that he or she is not at the time of signing in arrears to the City of Palmyra for past due or delinquent utility bills, and he or she does not owe the City of Palmyra any money from any source. Should it be necessary to refer this account to a collection agency, the undersigned agrees to pay all applicable fees, including court costs and interest. Any statements made and found to be false at a later date may result in immediate termination of utility service. In the event that only one adult signer leaves the household the deposit will remain with the other adult signer. All signatures are required before any utility service is provided.

AGREE

DISAGREE

Free Text

Thank you for contacting us.
We will get back to you as soon as possible.

Oops, there was an error sending your message.
Please try again later.

Prefer to print and deliver/mail your Utility Services application? Click the button below to print/download.

APPLICATION FOR UTILITY SERVICE