Do I need a notary for the General Facilities Use Form?

No. Sign and date the application without a notary. The form requires an insurance certificate and applicable insurance evidence, but does not specify a sworn or notarized attachment.

How do I submit the General Facilities Use Form?

Return the completed, signed application to the Village Office with the required insurance certificate and any fee required. The form says a permit is issued upon approval.

What information does the facilities use application request?

It asks for the requested facility and event dates and times, organization or individual details, event activities, group size, vendors, and a person in charge.

What insurance documents does the form require?

The form calls for a certificate of insurance and a copy of the Additional Insured Endorsement. Individual residents without a special event liability policy must provide a homeowners or renter’s policy declarations page.

Port Jefferson, NY · Suffolk County

No notary required

General Facilities Use Form With Insurance Requirements

This application requests permission from residents, organizations, or individuals to use an Incorporated Village of Port Jefferson facility for an event.

What this form is

This application requests permission to use a Village of Port Jefferson facility for an event. Applicants identify the requested facility, dates and times, event activities, attendance, vendors, and contact person; the Village issues a permit after approval. It also sets facility-use conditions and explains required insurance documents, including a certificate and applicable policy evidence.

Who needs it

An individual or organization seeking to use a Village facility for an event should complete and submit this application.

How to submit it

Return the completed application to the Village Office. The form says a permit is issued upon approval and requires the signed application, insurance certificate, and any required fee to be returned to the Municipality.

About notarization

This document is signed and dated without a notary; applicants must provide the required insurance certificate and applicable insurance evidence, but no sworn or notarized attachment is specified.

How to submit this form

1
Download the Application
Download the General Facilities Use Form and review the facility-use policy and insurance requirements.
2
Complete the Application
Fill in every blank, including the facility, requested dates and times, event details, and contact information.
3
Gather Insurance Documents
Obtain the required insurance certificate and applicable insurance evidence for your organization or individual application.
4
Return It to the Village
Submit the signed application, insurance certificate, and any required fee to the Village Office.

Frequently asked questions

Do I need a notary for the General Facilities Use Form?: No. Sign and date the application without a notary. The form requires an insurance certificate and applicable insurance evidence, but does not specify a sworn or notarized attachment.
How do I submit the General Facilities Use Form?: Return the completed, signed application to the Village Office with the required insurance certificate and any fee required. The form says a permit is issued upon approval.
What information does the facilities use application request?: It asks for the requested facility and event dates and times, organization or individual details, event activities, group size, vendors, and a person in charge.
What insurance documents does the form require?: The form calls for a certificate of insurance and a copy of the Additional Insured Endorsement. Individual residents without a special event liability policy must provide a homeowners or renter’s policy declarations page.

Need something notarized?

This General Facilities Use Form With Insurance Requirements doesn’t need a notary — but if you have another Port Jefferson form that does, a commissioned online notary can help.