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<br /> <br />'" <br /> <br />.,. <br />': <br />.{. <br /> <br /><. <br />., <br /> <br />efvi{[e <br />'Esta6Bsfiet{ 1857 <br /> <br />1880 !Main Street (;) Cente1'lJi{{e,9vf!J( 55038 <br />(651) 429-3232 I!t!fClJ( (651) 429-8629 <br /> <br />CITY OF CENTERVlLLE <br />APPUCATlON FOR A 1 TO 4 DAY TEMPORARYIEVENT ON SALE LIQUOR LICENSE <br />(Organization or location limited to 3 permits in a 12 month period) <br /> <br />Type or Print Information <br /> <br /> <br /> <br />~. <br /> <br />Date Org8f1iz~ <br />q \\~ \18 <br />City <br />~&l\Vi.-VI ~€. <br />Business Phone <br />u"":;a\ '-n.~ "'~ <br />Type of Organization <br />o CLUB 0 CHARITABLE 0 REUGIOU 0 OTHER NON- <br />Address <br />li\~ <br />Address <br />'1\SS <br />Address <br /> <br />~ c...~. <br />~,~ Ut.. <br /> <br />~ ~.h ~""" <br />vt" . <br /> <br />Will the applicant carry liquor liability insurance? If so, the carrier's name and amount of <br />, coverage. " <br /> <br />1';. <br />I <br /> <br />APPROVAL <br />APPUCATlON MUST BE APPROVED'BY CITY COUNCIL PRIOR TO SUBMISSION TO UQUOR CONTROL <br />CITY OF CENTERVILLE DATE APPROVED <br />FEE AMOUNT $ LICENSE DATES <br />DATE FEE PAID <br /> <br />C. Clerk <br />NOTE: Submit to the City of Centerville at least thirty (30) days prior to event. <br /> <br />Signature of Applicant:"'" <br /> <br />~) <br />