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2. Temporary Food Service Permit Application
3. 
5. Event name:
7. Date(s) & Time of Event:
9. Location of Event:
11. Business Name:
12. Phone:
14. Permanent Address (City & Zip):
16. Applicant Name:
17. Home Phone:
19. Home Address (City & Zip):
21. Check one:

    1. Individual

    1. Corporation

    1. Partnership
23. Owner's Name & Title:
24. Phone:
26. Owners' Address (City & Zip):
28. Food to be Served:
30. Prior Similar Experience:
32. Copy of Village of Skokie Food Service Guidelines Received?

    1. Yes

    1. No
34. ********FOR NON‐SKOKIE BUSINESSES********
    PLEASE ATTACH A COPY OF YOUR MOST RECENT ROUTINE FOOD INSPECTION REPORT
36. Signature of Applicant:
37. Date:
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit Submit and Print

* indicates a required field