Alcoholic Beverage Permit Application
This permit is for limited use only! No member of the group under 21 year of age may consume
alcoholic beverages under the rules of this permit. Alcoholic beverages in Herman Park are limited to
the picnic area (pavilions) and not permitted in recreation areas. This permit is valid only for the stated
date(s).

Purchaser has sole responsibility of liability and is to comply with all State/Federal laws. Subject to all
other statutes, rules and regulations, including, but not limited to, those of the Division of Alcoholic
Beverage Control of the State of New York.
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Group / Organization Name
Address *
Applicant's Name & Title *
Email *
Address *
Designated Area of Use *
Date of Use
This permit is for limited use only! No member of the group under 21 year of age may consume alcoholic beverages under the rules of this permit. Alcoholic beverages in Herman Park are limited to the picnic area (pavilions) and not permitted in recreation areas. This permit is valid only for the stated date(s). Purchaser has sole responsibility of liability and is to comply with all State/Federal laws. Subject to all other statutes, rules and regulations, including, but not limited to, those of the Division of Alcoholic Beverage Control of the State of New York. *
E- Signature *
Today's Date *
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