HomeMy WebLinkAboutSvoboda, Mark t
970 Peconic Lane
Ken Reeves P.O.Box 267
Recreation Supervisor ' Peconic,NY 11958
Town of Southold 631.765.5182
Ken.Reeves@town.southold.ny.us
TOWN OF SOUTHOLD
�3 RECREATION DEPARTMENT �3
s�"`' j APPLICATION FOR WEDDING CEREMONY ? 's-n- r y
1..,�,r 101 ON SOUTHOLD TOWN BEACHES 011 1 1
k \ 's.."E
"r �0 PLEASE PRINT LEGIBLY ' •'
APPLICATIONS DUE AT LEAST
TH'__E 3 0NTHSB F1 ' E NT
Today's Date: 10/7611 3
Applicant's Name: AAairg SVDIoVnA a
Address: 2- l j Sfi !i Ok/ i'? / y //all
Home Phone: Business Phone:
Cell Phone:7 2y-,23�lj�tl mail address: rM k loorOrre fri o-inKi J,(.v/7i
Name o ;rid room/Spouse#1: ( i/- l
1 l US
Name of Bride/ roo p' pouse#2: I 04 SV O b D d a
Beach Requested: ) 1 e 1 r 1[,i s
(Town Beach,Gull Pond,Kenney's,MtCabe's,New Suffolk,Goose Creek,etc.)
Number of Guests: 20 Number of vehicles:
Day and date of use: 61/1 3' I Li
Length of ceremony: From: A.M. P.M.4' To: A.M.I:4)0 P.M.
Number of temporary parking permits requested: 3 0
Please allow ample time to set up and dean beach after use. Town beaches are
closed from dusk until dawn.
Is the bride/groom/spouse a resident of the To of Sou Id? OYES • O
Applicant's Signature: ..-
FEES:
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 )
This Agreement is made this day of 0 , 2013, between the Town of
Southold(hereinafter"Town")and re AWC 51/of3ef.
(hereinafter"Applicant").
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 w'th the event
permitted by this approval.
APPLICANT:
By: /�s✓ j�
Sworn to before me this
30 day of 049 41 201.2 ADAM.1 HALPERN
Notary Public,State of New York
No. in iOn 70789
QQualified d M Klnpa County
Commission Expires Odober 22,2016
Notary Public
ectcf
FOR OFFICE USE ONLY
FACILITY IS: REQUEST IS:
AVAILABLE {1 APPROVED { }
NO V ABLE { ) DENIED { )
Recreation Department Supervisor
CERTIFICATE OF INSURANCE REQUIRED? V Y LA'S U NO
Application fee of 0$50 13$75 received on:
Date Check Number
Deposit of$250 received on:
Date Check Number
,� I SUFFOUr
1
ELIZABETH A.NEVILLE,MMC �
�� G,j, Town Hall,53095 Main Road
6 P.O.Box 1179
TOWN CLERK p
H Z Southold,New York 11971
Prt
REGISTRAR OF VITAL STATISTICS : Q � Fax(631)765-6145
MARRIAGE OFFICER � I •0' Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER : 6! Alt 4
FREEDOM OF INFORMATION OFFICER �'��� www•southoldtownny.gov
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
April 7, 2014
Mark Svoboda
205 Amity St
Brooklyn NY 11201
RE: Beach Parking Permits for 9/13/2014 Wedding
Dear Mr. Svoboda:
Enclosed herewith are 30 permits for your wedding guests to park at Kenney's
Beach, Southold on September 13, 2014 for your wedding ceremony. Please have
your guests place the permit on the vehicle's dashboard, passenger side. Failure
to display the permits could result in the vehicles being issued parking tickets.
I have also included the receipt for the Beach Wedding permit and the Clean-up
deposit.
I'll keep my fingers crossed that you have beautiful weather for you special day.
Very truly yours,
Linda J. Cooper
Deputy Town Clerk
Enclosures
Cooper, Linda
From: Cooper, Linda
Sent: Tuesday, April 08, 2014 12:08 PM
To: Flatley, Martin
Cc: Kruszeski, Frank; Blasko, Regina (rblasko @town.southold.ny.us)
Subject: Beach Wedding Parking Permits
Attachments: beach wedding_20140408105417.pdf
Attached is a copy of beach parking permits which will be used in September at Kenney's Beach. I know it's a long way
off and normally I don't send out the parking permits until 3-4 weeks before the wedding but the bride wanted to make
sure she has the permits way, way, way ahead of time.
Thanks.
Deputy Town Clerk
Town of Southold
631-765-1800
70'react tice 404eat/teak rjoa mat jvWt 6elleve you caA.
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SOUTHOLD TOWN BEACH PARKING PERMIT
for
Svoboda/Kallus Wedding
This permit allows entrance and parking at:
Kenney's Beach
Saturday, September 13, 2014
7:00 PM - 7:30 PM
Elizabeth A. Neville
Southold Town Clerk
(seal)
Display permit on vehicle's dashboard, passenger side
* * * RECEIPT * * *
Date: 04/04/14 Receipt#: 166882
Quantity Transactions Reference Subtotal
1 Guarantee Bid Deposits 9/13/14 Wedding $250.00
Total Paid: $250.00
Notes:
Payment Type Amount Paid By
CK#458 $250.00 Svoboda, Mark J.
Name: Svoboda, Mark J.
2417 41st St., Apt 3f
Astoria, NY 11103
Clerk ID: LINDAC Internal ID:9/13/14 Wedding
* * * RECEIPT * * *
Date: 04/04/14 Receipt#: 166873
Quantity Transactions Reference Subtotal
1 Beach Wedding 9/13/14 KB $50.00
Total Paid: $50.00
Notes:
Payment Type Amount Paid By
CK#458 $50.00 Svobada, Mark J.
Name: Svobada, Mark J.
2417 41st St., Apt 3f
Astoria, NY 11103
Clerk ID: LINDAC Internal ID:9/13/14 KB