180 S. Main St., Ste. 252, Martinsville, IN 46151

765-342-6621, Fax: 765-342-1062 morgancohd@morgancountyhealth.com

Online Application for Temporary Food Permit

Online:

$40.00 per food establishment. Please fill out one form for each unit. You may combine payments for your units, but you must upload the GovPay receipt to each form.

Credit or debit card via the GovPay website:

GovPay Button

***Please note: When paying online, you MUST include a copy of the receipt from GovPay with your application forms.

Name of Establishment:*
Phone:*
-
Mailing Address:*
E-mail:*

Email addresses are solely used as contact information and will not be shared with 3rd parties.

Owner's Name:*
Owner's Address:*
Owner's Phone:*
-
Certified Food Handler's Name and Date of Expiration:*

Note: If Exempt from this requirement, please write "Exempt" in the box above. Please upload a copy of the Certified Food Handler Certification for our records below.

Upload a Certificate for Food Handler:
Location(s) of Temporary Establishment/ Festival names:*
Go paperless! Please indicate below if you would prefer electronic notification regarding your permit(s):

Payment Information

*The permit fee for a temporary food permit online is $40. The fee may be paid at govpay, (see link button above).

Total amount paid to GovPay:*
GovPay Transaction Number:*
Upload a Copy of GovPay Transaction Receipt (jpg, jpeg, png, gif, doc, docx, xls, xlsx):*

***If exempt from the permit fees because of not-for-profit status that has been PREVIOUSLY approved by this department, please write exempt above, and also fill out the form "Application for Waiver of Fees for Not-for-Profit Establishments" found on the Food Permits page.

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