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

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

Online Application for Waiver of Fees (NFP)

Application for Exemption from Not-for-Profit Food Establishment Fees

Name of Establishment:*
Address of Establishment:*
Current Permit Number:*
Name of Representative:*
Phone for Representative:*
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E-mail:*

Please explain in the space below any reasons why you believe that your not-for-profit establishment should be exempt from the food establishment fees. Please note: Per the Morgan County Retail Food Establishment Ordinance, if you receive any payment, remuneration, or receive anything of value in exchange for the preparation or distribution of foodstuffs, cooked or uncooked, your establishment will not be considered to be eligible for this waiver.

Explanation:*
Word Verification: