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Rev: May-26 TOWN OF BOSTON (B) Display Date / Time: _________________________ Expected Duration: _________________________ (C) Display Location: ________________________________________________________________________________ (D) Display Content: ________________________________________________________________________________ ________________________________________________________________________________________________________ (E) How will fireworks be stored prior to display? ______________________________________________ (F) Rain date for display: ___________________________________________________________________________ (G) If rained out, how will fireworks be stored? __________________________________________________ I attest that the information contained in this permit application is accurate, true and complete to the best of my knowledge, and I understand that false statements made in this permit application are subject to the applicable versions of the NYS Penal Law. ___________________________________ ___________________________ Signature of Applicant Date 3 Page Town of Boston 8500 Boston State Road • Boston, New York 14025 Phone (716) 941-6113 • Fax (716) 941-6116 www.bostonNY.gov