Form Center

2. Borough of Hawthorne

   Board of Health

   445 Lafayette Avenue, 2nd Floor
   Hawthorne, NJ 07506

   Phyllis Wooldridge

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

   https://hawthornenj.org/269/Health

4. Business Name*
6. Business Address*
8. Business Phone Number
10. Type of Business
12. Owner Name*
14. Owner Address
16. Owner Telephone Number
20. I hereby make application for a license to sell milk within the municipality of Hawthorne.

    The source of supply is as follows:

22. Name and Address of Producer

    Please number each item. 

24. Annual Fee: $30 - 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. 

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

    
    

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

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