Police Department
POINT TOWNSHIP
Northumberland, PA
R.D. 2, Northumberland, PA 17857
Phone 570-473-0114

APPLICATION FOR SOLICITATION PERMIT

Name _________________________________________________________

Name of Employer or Principal ______________________________________

Date of Birth ____________________________________________________

Address _______________________________________________________

Address (Temporary) _____________________________________________
Address to which notices under this ordinance are to be sent:
                            Splash Magic Campground
                            213 Yogi Boulevard
                            Northumberland, PA 17857
Address of Employer or Principal _____________________________________

Nature of Business ________________________________________________

Have you ever been convicted of a crime?     Yes _______  No ______________
If so, What crime: (Do not list traffic violations)
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________

Individuals operators license number ___________________________________

Issuing State _____________________________________________________

Make of Vehicle __________________________________________________

Year and Type of Vehicle ___________________________________________

Registration Number of Vehicle _______________________________________

Signature of Applicant ______________________________________________

Fees:   Per Day $7.50                                    Six Month  $75.00
           Per Month  $35.00                              Yearly  $100.00