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:l Centerville <br /> Special Event Permit Application <br /> 1. TI TLE, PURPO E, AND BRIEF DESCRIPTION 2F EVENT: <br /> New Application: Renewal / of or Change in Application: <br /> CONTACT PERSON: y _ "l p-so /`� <br /> TELEPHONE: / OR <br /> 2. IDENTIFYING INFORMATION: <br /> Attach a written communication from the organization(s) in whose name the event will be advertised which <br /> authorizes you, the applicant, to apply for this special event permit on its /their behalf. <br /> Applicant's Name: 0/V" �' L7� �✓ Title: i!g�qmT <br /> Address: �(�' /,y.� S Thy :5;r GU#i 7"r✓"�>g2 CA AZ <br /> Mailing Address: :5414F <br /> Affiliation: <br /> Day Phone: 7oS� -74 D / Evening Phone: �v <br /> Emergency Phone: Lr�/ '6 `1 <br /> 3. EVENT PRINCIPALS: <br /> Following, please list the names, addresses and telephone numbers of all the principals involved in any of the <br /> proposed special event. Include professional event organizers, event promoters, financial underwriters, commercial <br /> sponsors, charitable 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. <br /> Name: r <br /> Organization/Business /Agency /Affiliation: ✓ /�AC.� ! !?,�G�o2 <br /> Is this a non - profit organization? Yes _X_ No <br /> If you are making application under non -profit status, proof of non- grofit status must be attached to this application <br /> Mailing Address: <br /> Day Phone: Evening Phone: <br /> Title and functional responsibility with regard to the event: �'i A L`c iD /R ' 014 <br /> A) t 1LL11 A/U <br /> �Sl -25l -5 <br /> �jGL - oR/V fin` --oN 708 4'.N2vc jc4rn: MvAa <br /> Page 1 of 10 <br />