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Food Establishment Permit Application

  1. Street, Town/City, State & ZIp Code
  2. Name(s) of person(s) who are Certified Food Protection Managers
    NEW establishments submit copies of certificates to
  3. Name of Person(s) who have received Allergen Awareness Training
    NEW establishments submit copy of certificate
  5. I, the undersigned, attest to the accuracy of the information provided in this application and I affirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been instructed by the Board of Health on how to obtain copies of 105 CMR 590.00 and the federal Food Code. For copies of applicable regulations, go to:
  6. Typing in your name will be considered an electronic signature.
  7. Pursuant to MGL Ch. 62C, sec. 49A, I certify under penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid State taxes required under law.
  8. Typing in your name will be considered an electronic signature.
    Payment can be made online by clicking on the link below, or a check made payable to "Town of Winchester," can be mailed to: Health Dept., 71 Mt. Vernon St, Winchester MA 01890. Permit is not considered complete until all documentation is received, and fee is paid. Permit will not be processed until application is complete and fee is paid.
  10. Leave This Blank:

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