PERMIT APPLICATION
CITY OF DOVER, NEW HAMPSHIRE
Check( √) the type of application:
PARADE**______, ROAD TOLL***______,
Fill In Completely and Return To City Clerk -- PLEASE NO LATER THAN 30 DAYS PRIOR TO EVENT
Organization Name:_____________________________________________________________________________
Federal Tax ID number for Organization:___________________________________________________________
Check( √ ) Nature of Organization:
Religious___, Educational___, Charitable___, Civic___, Sports___, Veterans___, Fraternal or Political___, Other___
Name/Description of Event (if applicable): ________________________________________________________
Contact Person:_______________________________ Day Time Telephone: ____________________________
Address: ___________________________________________ Email___________________________________
Date of Event: ___________________________ Specific Time: ________________________________________
Location of Event (if parade, attach course description or map): ______________________________________
*********PARADE PERMITS*********
**NOTE: ALL REQUESTS FOR PARADE PERMITS MUST HAVE PARADE ROUTE APPROVED BY
THE POLICE DEPT. BEFORE GOING ON THE COUNCIL AGENDA
Police Department Parade Route Approval Signature:____________________________________________
Printed Name:_________________________________ Check Here If Parade Route Is Attached:__________
*********ROAD TOLL PERMITS*********
***NOTE: SOLICITING DONATIONS IS PROHIBITED FROM THE ROADWAY WITHOUT SPECIAL
PERMISSION FROM THE POLICE DEPARTMENT
Road Toll Location: __________________________________________________________________________
Police Department Road Toll Approval Signature: _________________________________________________
Printed Name: _______________________________________________________________________________
Unless expressly waived in writing by the Licensing Board, the Organization agrees to defend, indemnify, and
hold harmless the City of Dover from any claims, losses, and/or damages arising out of the event, and to name
the City of Dover as an additional insured on its general liability insurance policy in amounts of not less than
One Million Dollars ($1,000,000) per occurrence and Two Million Dollars ($2,000,000) in the aggregate.
The Organization/Applicant shall provide the City a certificate of insurance evidencing such additional
insured status no less than fifteen (15) days prior to the event.
I CERTIFY THAT THE ABOVE STATEMENTS ARE TRUE AND CORRECT. I UNDERSTAND THAT THIS
PERMIT IS ISSUED BY THE CITY COUNCIL per the provisions of RSA 287-A, RSA 31:91 and/or RSA 286 and I agree
to abide by the same.
SIGNATURE OF APPLICANT: __________________________DATE:_______________________
(duly authorized)
PRINTED NAME:__________________________________
Licensing Board Approval___________________________ Date:_________________________
1/2015
http://www.dover.nh.gov/Assets/government/city-operations/1form/finance/city-clerk-tax-collection/Application%20parade.pdf