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Fireworks Online Application Supplement

• If you store fireworks in Texas, complete Part I.

• If you are a pyrotechnic operator applicant, complete Part II.

• If you are applying for an agricultural, industrial, or wildlife control permit,complete Part III.

Applicant information

First name Middle name Last name Suffix

Company information

Company name

Part I – for fireworks storage in Texas For the fireworks you have stored, please indicate the:

• Classification – either 1.3G or 1.4G.

• Location - the address where the fireworks are stored. If there is no specificaddress, describe the exact location.

• Estimated weight – the estimated maximum gross and net weight offireworks stored during the year.

o The net weight is the weight of all pyrotechnic and explosivecompositions and fuses only.

Classification Location Street address, city, and state

Estimated Weight Gross Net

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Part II – for pyrotechnic operator applications • Not for special effects or flame effects.

• List five permitted or licensed 1.3G fireworks displays that you assisted inconducting in Texas that were under the direct supervision of a pyrotechnicoperator licensee in Texas.

• Verify the pyrotechnic operator by providing their signature below or by anotherform of written confirmation.

Public Fireworks Display Experience

City Date Pyrotechnic Operator Information

Name License No. Signature

Part III – for agricultural, industrial, or wildlife control permit applications

1. Describe the type of fireworks you will using.

2. Indicate the specific purpose for which the fireworks will be used.

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3. Specify the location where the fireworks will be used.

4. Your permit must be available for inspection. Specify where the permit will be kept.Include a physical address if available.

5. Provide the name and license number of the licensed distributor supplying thefireworks.

Distributor name License number

Visit our website at www.tdi.texas.gov/fire for licensing information, forms, and SFMO contact information.

Your rights: You can request information we have about you by emailing OpenRecords@tdi.texas.gov or writing to: Public Information Coordinator, Texas Department of Insurance, PO Box 12030 (mail code 112-1C) Austin, Texas 78711-2030. You also have the right to ask that we fix information we have about you that is wrong. To ask for a correction, send (1) your name, mailing address, and your phone number, (2) details about what needs to be fixed, and (3) the reason or proof showing why the information is wrong. Send this by email to RecordCorrections@tdi.texas.gov or by mail to: Record Correction Request, Texas Department of Insurance, PO Box 12030 (mail code 113-1C), Austin, Texas 78711-2030. There is a different process to change or update information you submitted to the State Fire Marshal’s Office (SFMO). To update information submitted to SFMO, email FMLicensing@tdi.texas.gov. There may be a fee to update information held by SFMO.