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Town of Middletown, RI
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Town of Middletown
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Application Form
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Application Completion
Instructions
Please submit this form using any of the contact methods provided below.
Provider Phone
401.846.1144 x7076
Application
Reference Number
VAESGJHZ
Permit Status
Unknown
Application Phase
Other Public Access
Application Type
Mooring Permit
Permit Type
Application Comments
Applicant
Last Name
First Name
Middle Name
Suffix
Contact Information
Mailing Street
Mailing City
Mailing State
Mailing Zip
Home Phone (Winter)
Home Phone
Work Phone
Mobile Phone
Email Address
Additional Information
Emergency Contact Name
Emergency Contact Phone
Vessel
Length (ft)
feet
inches
Vessel Photo(s)
(Maximum file size=4MB)
Wait List
Wait List Selection
List Name
Mooring
Berth
Location
Location on Application
Latitude
Degrees
Minutes
Seconds
Longitude
Degrees
Minutes
Seconds
Acceptance
Terms and Conditions
30%">
All information I am providing is correct to the best of my knowledge.
I have read and understand the Online Mooring
User Terms and Conditions
Signature
Date
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