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2019 Renewal Application for Monroe County Emergency Management Placard Program

  1. Application Instructions

    • All questions must be answered in full for form submission
    • Applications that do not provide complete information will be denied
    • If a question does not apply to your business/organization, use NA as a response.
    • Applications that provide false/misleading information will be denied and may be banned from future consideration in the Placard Program

  2. If more than one location, provide administrative address in Monroe County

  3. Should be individual completing this application

  4. Note: The Placard Program is only intended to be used by your employees or individuals directly supporting your business functions. If approved for early reentry, anyone entering the County using your placard is entering an area under State of Emergency that has not been deemed safe. This program is not intended for use by family or friends of those reentering to support your business/organization. Misuse may result in removal from the Placard Program)

  5. The intention of the Placard Program is to facilitate the speedy reentry of all Monroe County residents through the efficient restoration of essential services (water, emergency medical services and passable roadways). The effective reentry of those businesses/organizations necessary to aid in this effort is mission essential. Please answer the following questions Yes or No:

  6. Type in your name as authorized agent.

  7. Please upload your current business license.

  8. Leave This Blank:

  9. This field is not part of the form submission.