Form Center

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. Name of Applicant*
6. Address*
8. Phone Number
10. Owner Name*
12. Owner Address
14. Manager or Person In Charge on Premises
16. Name
18. Address
20. Phone Number

22. Annual Fee: $125 - 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

    
    

24. Signature of Applicant*
25. Date*
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26. Print Only

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