*(required field)
*I have read and understand the open burning policy. Furthermore, I understand if I choose not to follow said rules I will be subject to having my open burning privilege revoked and issued a citation. Citations for illegal burning range from $100-$1,000 plus court cost.

Responsible Person's First and Last Name
*

Address
*

City
*

Address of Open Burn
*

City
*

Phone Number
*