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2. Borough of Hawthorne

   Health Department

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

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

   https://hawthornenj.org/269/Health

4. Business Name*
6. Business Address*
8. Business Phone Number*
10. Owner Name*
12. Owner Address
14. Owner Contact Number*
15. Email Address*
19. I hereby make application for a license to sell ice within the municipality of Hawthorne.

    The source of supply is as follows:

21. Name and Address of Producer

    Please number each item. 

23. Annual Fee: $25 - 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.org

25. In consideration of such license, I hereby agree to comply at all times with the legal requirements for the sale of ice.
27. Signature of Applicant*
28. Date*
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29. Print Only

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