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2. Borough of Hawthorne

   Health Department 

   445 Lafayette Avenue, 2nd Floor
   Hawthorne, NJ 07506
   Phyllis Wooldridge

   Phone: 973-427-4012  ~  Fax: 973-427-1882

   https://hawthornenj.org/269/Health

4. Forms must be filled in completely before a license can be issued.
6. Business Name*
8. Business Address*
11. Business Phone Number*
13. Business Owner Name*
15. Address
17. Contact Number*
18. Email Address*
22. Dealer List
    • List below names of dealers who make deliveries to your store
    • Mobile trucks must list names of industries served
24. Dealer Names, Addresses, and Product

    Please number each item. 

26. Annual Fee: $225 - January 1 to December 31 

    Cash or Check only - Checks made payable to: The Borough of Hawthorne

    Please mail or deliver application and fees to the Health Department NO LATER THAN January 31st. 
    Your license will be mailed to you, Please post in public view.
    Thank you for your continued business in the Borough of Hawthorne. 

    Any questions or concerns may be directed to the Registrar at: pwooldridge@hawthornenj.or

28. Important

    Licenses are non-transferable and must be renewed each year no later than January 31st. If you are a new business or new business owner, you must obtain a Certificate of Occupancy from the Building Department before moving into the premises. 

30. Signature of Applicant*
31. Date*
Leave This Blank:


32. Print Only

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