Kingston & St Andrew Municipal Corporation Places of Amusement Application for License

(if more than one building on site, identify the one being licensed, e.g building #2 or building at rear)

In the parish of Kingston and St.Andrew for the following type of amusement

(please indicate the of amusement/entertainment that will take place)

Declaration:I hereby declare that the details finished above are true and correnct to the best of my knowledge and belief, and, I undertake to inform you of any changes therein immediately. In case any of the information above is found to be false, untrue, misleading, or found to be a misrepresentation, i confirm that i may be held liable for same.

Special Events Billboards & Signs

All Applications dor Amusement Licenses are being adviced that permission from the Kingston and St. Andrew Municipal is required to display advertisement for the event being promoted/hosted. Failure to apply will result in any of the fillowing:

• Removal of Billboards and/or signs & banners
• Refusal/Revocation of Amusement License
• Recovery of cost of removal
• Application of penalty under the Anti-Litter Act.

Please fill out the form below as applicable to your event.

I will be displaying the following at/leading up to my event.

Declaration:I hereby declare that the details finished above are true and correnct to the best of my knowledge and belief, and, I undertake to inform you of any changes therein immediately. In case any of the information above is found to be false, untrue, misleading, or found to be a misrepresentation, i confirm that i may be held liable for same.