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

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

Online Food Permit Application

Online:

See fees for permits here.

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. Please fill out one form for each establishment. You may combine payments for your establishments, but you must upload the GovPay receipt to each form.

*For Full-Time and Part-Time Food Establishments*

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

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

Mailing Address:
Owner's Name:*
Owner's Address:*
Owner's Phone:*
-
Type of Establishment:*
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 Certification for Food Handler:
List months of operation, if open only part of the year:
Go paperless! Please indicate below if you would prefer electronic notification regarding your permit(s):

Payment Information

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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