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�V � <br /> - - , ; � ��� <br /> � '� � <br /> erv tet�nC�e � � • <br /> ��� Centerville � ` � <br /> � <br /> Special Event Permit Application <br /> 1. TITLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: �� L� �� <br /> New Application: _�� Renewal of or Change in Application: �� <br /> � �•-- <br /> CONTACT PERSON: �a�.rc,�. � r���L <br /> TELEPHONE: (� I 2- 3g (o - 733�. OR <br /> 2. IDENTIFYING INFORMATION: <br /> Attach a written commwu from the organization(s) in who name the event will be advertised which <br /> authorizes you, the applicant, to app this special event pe ' on its/their behalf. <br /> Applicant's Nazne: . Title: <br /> Address: � E, � <br /> Mailing Address: <br /> Affiliation: � <br /> Day Phone: Evening Phone: <br /> Emergency Phone: , <br /> I <br /> 3. EVENT PRINCIPALS: I <br /> Following, please list the names, addresses and telephone numbers of all the principals involved in any of the I <br /> proposed special event. Include professionaI event organizers, event promoters, financial underwriters, commercial '� <br /> sponsors, chazitable agencies for whose benefit the event is being produced, the organization(s) in whose name the <br /> event is being advertised, and all others administratively, financially and organizationally involved as principals in ' <br /> the production of the proposed special event. Make additional copies of the following as needed to include as of the <br /> principals involved in the proposed special event. I <br /> �-. <br /> Name: 1 � � r � �.;� � <br /> OrganizationBusiness/Ag� y/Affiliation: <br /> 4� <br /> Is this a non-profit organization? Yes No <br /> If you are making application under non status, nroof of non status must be attached to this application <br /> Mailing Address: ��� ���� ��� �„ I �c� ���`Ll� i( t�--� <br /> Day Phone: �' � - ?��(� -� Evening Phone: <br /> TitZe and funcrional responsibility with regard to the event: <br /> Page 1 of 10 <br /> 13 <br />