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<br /> <br />tervi{{e <br />Tstab{isliecf 1857 <br /> <br />1880 Main Street . CentervilleJ iJvf!J..[ 55038 <br />(651) 429-3232 .:Fa?( (651) 429-8629 <br /> <br />CITY OF CENTERVILLE <br />APPLICATION FOR A 1 TO 4 DAY TEMPORARY/EVENT 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 />Date Organized Tax Exempt Number <br /> <br />Business Phone <br />... ?'f.:S'l <br />Type of Organization <br />o CLUB 0 CHARITABLE RELIGIOU 0 OTHER NON-PROFIT <br />Address <br /> <br /> <br />Organization Officer's Name <br /> <br />Address <br /> <br />Organization Officer's Name <br /> <br />Address <br /> <br />Location where license will be used. If an outdoor area, describe: <br /> <br /> <br />Will the applicant carry liquor liability insurance? If so, the carrier's name and amount of <br />covera e. <br /> <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY COUNCIL PRIOR TO SUBMISSION TO LIQUOR CONTROL <br />CITY OF CENTERVILLE B DATE APPROVED <br />FEE AMOUNT $ '* f JVI Vc;J- LICENSE DATES <br />DATE FEE PAID ~ <br /> <br />Ci Clerk <br />NOTE: Submit to the City of Centerville at least thirty (30) days prior to event. <br />