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2. Notice

   No permit will be issued until the $50 fee is received. Please make checks or money orders payable to "County of Henry" and send to:
   Henry County Fire Marshal's Office
   1024 DuPont Road
   Martinsville, Virginia 24112

4. Applicant Name*
6. Applicant Address*
8. City*
9. State/Province/Region*
11. Postal/Zip Code*
12. Country*
14. Applicant Phone Number*
16. Applicant Email*
18. Location of Burning*
20. City*
21. State/Province/Region*
23. Postal/Zip Code*
24. Country*
26. Emergency Contact
28. Emergency Contact Phone Number*
30. Notes*

    List any additional information for the Fire Marshal.

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field