STATE OF
You, _____________ _____________, of ___________________ are granted permission to purchase fireworks on and after __________ _____, 2008 of the following kind and quantity _________________________________________________________ [insert type and amount] to be used on ___________ _____, 2008 at ________________ ______________________ [insert location]. This permit is restricted to the above conditions.
Dated this ____ of ________, 2008.
____________________________
Town Chairman