STATE OF WISCONSIN
Town of ________
________ County
To ________ ________:
You, ________ ________, of ______________, are granted permission to purchase fireworks on and after ________ ___, 20__ [insert date], of the following kind and quantity ________ [insert type and amount] to be used on ________ ___, 20__ [insert date], at ________ [insert location]. This permit is restricted to the above conditions.
You are also to adhere to the following special conditions in Ordinance ________ [cite ordinance number and/or title] for the Town of ________, ________ County, Wisconsin: [list special conditions].
[If a bond or liability insurance policy is required, add the following:]
You are also required to file a [bond or liability policy, whichever requested] in the name of the Town of ________, in the amount of $________, that will indemnify other persons for any injuries to person or property arising out of the use of the fireworks.
Dated this ______ day of ________, 20__.
[Signature of town chairperson or designee]
Note: See
s. 167.10, Wis. stats., for other fireworks regulations. A copy of the permit shall be given to a town fire or law enforcement official at least 2 days before the date of authorized use. The bond or liability policy, if required, and a copy of the permit must be filed in the office of the town clerk.
