Do I need a notary for the Temporary Food Service Application?

No. The application requires the applicant’s signature and date, but it has no notary block. The required insurance proof or signed CE-200 exemption form is not identified as needing notarization.

What documents must accompany the application?

Include proof of workers’ compensation and disability benefits insurance, or a completed and signed CE-200 exemption form. The department says permits will not be issued without this paperwork.

When should I apply for a temporary food service permit?

Return the completed application at least 10 days before the first day of operation to help assure prompt permit issuance.

Chemung County, NY · Chemung County

No notary required

Temporary Food Service Application

Chemung County’s Temporary Food Service Application is for operators seeking a permit to serve food at a temporary event or seasonal location.

At a glance

Issued by: City of Chemung County · Chemung County, Chemung County, New York
Notarization: Not required: file this form without a notary.
Official source: chemungcountyny.gov
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

Use this application to request a permit to operate a temporary food service establishment in Chemung County. The form asks for operator and event details, including dates, food served, food source, and equipment. Apply at least 10 days before the first day of operation, and include proof of workers’ compensation and disability insurance or a completed CE-200 exemption form.

Who needs it

Operators planning to serve food at a temporary event or seasonal location in Chemung County need to submit this application for a permit.

How to submit it

Mail the application to Chemung County Health Department, Environmental Health Services, 103 Washington St., PO Box 588, Elmira, NY 14902-0588. Insurance documents may also be sent to [email protected] or faxed to (607) 737-2059.

About notarization

This application is signed and dated without a notary; the required insurance proof or signed CE-200 exemption form is not identified as needing notarization.

How to submit this form

1
Download the Application
Download the Temporary Food Service Application and review the instructions on the back.
2
Complete and Sign the Form
Provide operator and event details, food and equipment information, then print your name, sign, and date the application.
3
Gather Required Documents
Include proof of workers’ compensation and disability benefits insurance, or a completed and signed CE-200 exemption form.
4
Submit to the County
Mail the application to Chemung County Health Department, Environmental Health Services, in Elmira. Submit it at least 10 days before operations begin.

Frequently asked questions

Do I need a notary for the Temporary Food Service Application?: No. The application requires the applicant’s signature and date, but it has no notary block. The required insurance proof or signed CE-200 exemption form is not identified as needing notarization.
How do I submit the Temporary Food Service Application?: Mail it to Chemung County Health Department, Environmental Health Services, 103 Washington St., PO Box 588, Elmira, NY 14902-0588. Insurance documents may also be emailed or faxed to the department.
What documents must accompany the application?: Include proof of workers’ compensation and disability benefits insurance, or a completed and signed CE-200 exemption form. The department says permits will not be issued without this paperwork.
When should I apply for a temporary food service permit?: Return the completed application at least 10 days before the first day of operation to help assure prompt permit issuance.

Need something notarized?

This Temporary Food Service Application doesn’t need a notary, but if you have another Chemung County form that does, a commissioned online notary can help.