Please Print, Complete, and Mail to:
Borough of Madison
c/o Borough Clerk
50 Kings Road
Madison, NJ 07940

Date of Application:                              

To:  Mayor and Council

Name of Applicant: 

Address of Applicant: 

Telephone Number Where Applicant Can Be Reached During the Day:

Name of Street(s) to Be Closed Off:

Date of Block Party:

Rain Date of Block Party:

Starting Time of Block Party:

Ending Time of Block Party:

FOR BOROUGH USE: