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4180 – 105TH AVENUE


Applications must be submitted to the Town Clerk at least days 45 before the Event, 

along with the Rental Fee, plus the damage deposit (separate check).

By submitting this application, Renter agrees to abide by the Rental Policies of Palmer Township 

and acknowledges this application applies to Hall’s kitchen, meeting area, bathrooms next to the meeting area, and grounds.

Rental Fees

Non-Resident                  Township Resident           Governmental                     Non-Resident                           Resident

                                                                                          Unit                       Business/Organization           Business/Organization

        $150.00                     $35.00 for half of                    $0.00                               $500.00                           Suggested Donation: 

                                               a day rental                                                                                                                $35.00

Damage Deposit

Non-Resident                    Township Resident          Governmental                    Non-Resident                            Resident

                                                                                           Unit                      Business/Organization            Business/Organization

         $50.00                        $50.00                                  $0.00                              $100.00                                   $100.00                            

Date of the Event:_______________________Type of Event:_____________________

Applicant Information:

Name: ________________________________Date of Application:________________

Address:_______________________________Home Phone:______________________

_______________________________________Work Phone:_____________________

Rental Hours: Start time:____________End Time:_____________

Alcohol: Will any alcohol be brought to or consumed at the event? _____Yes _____No

IMPORTANT: Alcohol may not be sold or otherwise exchanged for compensation in any way in connection with the use of the Hall. If alcohol will be

present, the Town may require a licensed law enforcement officer to provide security for the event. The Town will require proof of insurance if alcohol is to be served.

Insurance: Applicant may be required to provide proof of liability insurance before the event in an amount determined by the Town.

Residency: Is the applicant a resident of the Town? _____Yes _____No

(If a business or organization, please provide a membership list to verify residents for resident rate)

Rental Fees and Damage Deposit: A non-refundable application fee must be paid at the time of submitting the application. All additional fees and a damage deposit, must be paid to the Town at least 14 days before the event, or this application is voided. The applicable fees are those as set by the Town in its Township Hall Rental Policy.

Applicant understands and agrees that if its application is approved, applicant is fully responsible for the event and is subject to the terms and conditions of the Township Hall Rental Policy.

Applicant’s Signature:_________________________________Date:_______________


Application Approval

Application Approved?     Yes:      No:

If “No”, the reasons(s) for the denial:

Conditions or modification of policy for approval

Conditions or modifications of approval include: (if none, list “None”)


Rental Fee: $ __________ (Paid on: _____/_____/20____)

Damage Deposit: $ __________ (Paid on: _____/_____/20____)

Any deductions:

Damage Deposit returned on (if applicable): _____/_____/20____

After Rental

Any signs/reports rental policy was not followed:

Any follow-up communication with the Renter:

Was the Rental Policy followed: Yes:        No:

If “No”, what policies were not followed:

For the Town

Printed Name: _________________________Signature: ____________________________

Date: ______/______/20_____

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