Village of Raymond
$4.00 USE PERMIT
Allows you to purchase, possess & transport your fireworks.
Allows use of fireworks only on the date, time & place specified on the permit.
Type of Permit:
Private Use ·
The kind and quantity of fireworks, which may be purchased: •
10 cases of 1.4G UN0336.
The date and time of permitted use: JULY 11th, 2020 8 PM – 10 PM
2720 W 5 Mile Rd, Caledonia WI, 53108.
Terms and Conditions:
No other use date or location is permitted in the Village of Raymond without the
express written permission of the Village of Raymond. This permit is issued upon •
the condition that the Village of Raymond, and its appointed and elected officials and employees and Racine Fireside Corporation shall not be liable in any civil action for any accident or injury occasioned during the transportation, handling, storage, or use of said fireworks. Permit applicant to accept full responsibility and liability. The applicant hereby releases, indemnifies and holds harmless the Village of Raymond and all it’s appointed and elected officials and employees and Racine Fireside Corporation from any and all liability and damages relating to the fireworks and or the use of any of the fireworks purchases whether the claimant is the user or a third party. A copy of the permit holder’s license or ID acknowledges these conditions and shall be kept on file and available for inspection •for a period of not less than seven years following the issue date of the permit. ‘
The undersigned Village President of the Village of Raymond, County of Racine,
Wisconsin, hereby authorizes the following person to purchase up to 10 cases ‘
of 1.4G UN0336 fireworks.
Authorized by: Gary Kastenson Village President
COPY of LICENSE or STATE ID