HomeMy WebLinkAboutMeyer, Jocelyn e i
•,,'''"i- 970 Peconic Lane
Ken Reeves 0�7 � P.O. Box 267
Recreation Supervisor N Peconic,NY 11958
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Town of Southold b', 631.765.5182
"'--,_eourr �+>� Ken.Reeves @town.southold.ny.us
TOWN OF SOUTHOLD
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RECREATION DEPARTMENT
APPLICATION FOR WEDDING CEREMONY ttl, k
1.,,firi ON SOUTHOLD TOWN BEACHES qo,'/ON
1�.•• PLEASE PRINT LEGIBLY ��.•�
APPLICATIONS DUE AT LEAST
THREE(3)MONTHS BEFORE EVENT
Today's Date: Mal 301 -01-3
Applicant's Name: b l J -t in tnn V
44 Address: '-4 -O Sbv1(1 k-e- ) &Liti ' ) - NI y
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Home Phone: '-'-'5S-'"'"1--tPl ll Business Phone:
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J Cell Phone: .35-LM t-4-1 E-mail address: j r-( J.QX (ax°v t a n
\ Name of Bride/Groom/Spouse#1: er ��� S
Name of Bride/Groom/Spouse#2: 3O LL' L(n M Lt r
Beach Desired: SO O 41 1 3 WY\ Q L9Ovo \ 9-�
(Town Beach,Gull Pond,Kenney's,McCabe's,New Suffolk,Goose Creek,etc.) 1
Number of Guests: t Number of vehicles: 14
Day and date of use:
/c\)CSc- \,1 V3 LSwdCtA0
V Length of ceremony: From: O A.M. P.M. To: ' 1 A.M. P.M.
Number of temporary parking permits requested: Li
Please allow ample time to set up and clean beach after use. Town beaches are
closed from dusk until dawn.
Is applicant a resident of the Tow I of Sout 1 ld? DYES UNO
Applicant's Signature: APO AN4Sit"
FEES: NW •
Residents: Free of Charge Non-Residents: $50 (under 50 participants)
$75 (over 50 participants)
Refundable cleanup deposit of$250 required for all applicants.
Please note: Fees must be paid once application is approved. Checks made
payable to TOWN OF SOUTHOLD. Please submit separate
checks.
.TOWN OF SOUTHOLD 2013 INDEMNITY AGREEMENT
STATE OF NEW YORK )
) ss.:
COUNTY OF SUFFOLK ) ``
L
This Agreement is made this 14 day f U)v , 20(�, between the Town of
Southold(hereinafter"Town") and �c4y R. tteye(
(hereinafter"Applicant"). U t
In consideration of issuance by the Town's Recreation Department of an approval to
utilize a Town Beach, the Applicant voluntarily agrees to indemnify and hold the Town
and its officers, employees, and agents harmless from and against any and all losses,
liabilities, damages, or costs sustained by any person for personal injury, death, or
property damage arising out of, or as a consequence to the use of the Town property.
The undersigned further agrees to indemnify and hold harmless the Town and its officers,
employees, and agents from and against any and all losses, liabilities, damages, or costs
which may be imposed upon, incurred by or asserted against the Town by reason of any
act of omission of the undersigned, which result in damage or injury of any kind to any
person or any property and which arises out of or is any way connected with the event
permitted by this approval.
APPLICANT:
B
S Iorn to be ore me this
day of , 200.
BONNIE!.DOROSKI
Notary Public,State Of New York
otary P No.01D06095328,Suffolk C,etmty
Term Expires July 7,20 l
/!/I-!!/!11-1- 1•!/!!/!1!/!!!!f!/1!!/!AWW!/l-!/ ! /r! /!1!11//A
FOR OFFICE USE ONLY
FACILITY IS: REQUEST IS:
AVAILABLE { APPROVED { }
NOT ffAILABLE { } DENIED { }
Ule"`"
Recreation Department Supervisor
CERTIFICATE OF INSURANCE REQUIRED? DES El NO
Application fee of❑$50 ❑$75 received on:
Date Check Number
Deposit of$250 received on:
Date Check Number
• ,��'o�"gUFFO�,�ee
ELIZABETH A.NEVILLE,MMC ,��o� l/y N, Town Hall,53095 Main Road
TOWN CLERK o P.O. Box 1179
y Z ; Southold,New York 11971
REGISTRAR OF VITAL STATISTICS `�' ���
p .F Fax(631)765-6145
MARRIAGE OFFICER _y� • Telephone(631)765-1800
��
RECORDS MANAGEMENT OFFICER o,( * *ea �� www.southoldtownny.gov
�
FREEDOM OF INFORMATION OFFICER '-
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD TOWN PARKING PERMIT
for
Haas/Meyer Wedding
This permit allows for parking by:
SOUTHOLD TOWN GAZEBO
SATURDAY, AUGUST 17, 2013
10:00 AM to 11:00 AM
Elizabeth A. Neville
Southold Town Clerk
(seal)
Display permit on passenger side of vehicle dashboard
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