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<br /> <br />tervi[[e <br /> <br />'1:'la6lislid lS'i7 <br /> <br />Centerville <br />Special Event Permit Application <br /> <br />1. <br /> <br />TITLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: <br />Kids Fishing Contest" <br /> <br />1 st Annual "Fete Des Lacs <br /> <br />New Application: <br /> <br />x <br /> <br />Renewal of or Change in Application: <br /> <br />CONTACT PERSON: Todd Wolner <br />TELEPHONE: 763 783-5274 <br /> <br />OR <br /> <br />561-357-4958 <br /> <br />2. IDENTIFYING INFORMATION: <br /> <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 /> <br />Applicant's Name: _Todd Wolner Title: Contest Director <br />Address: 6887 Beaver Pond Wav Centerville. MN 55038 <br />Mailing Address: Same as above <br />Affiliation: <br />Day Phone: _763783-5274 Evening Phone: 651-357-4958 <br />Emergency Phone: 651357-4958 <br /> <br />3. EVENT PRINCIPALS: <br /> <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 /> <br />Name: 1st Annual "Fete Des Lacs Kids Fishing Contest" <br />Organization/Business/ Agency/Affiliation: Volunteer Organization & iniunction with <br />Centerville's Lion's Club <br /> <br />Is this a non-profit organization? <br /> <br />X Yes <br /> <br />No <br /> <br />If you are making application under non-profit status, oroof of non-Dfofit status must be attached to this aoolication <br /> <br />Mailing Address: 6887 Beaver Pond Way Centerville. MN 55038 <br />Phone: 763783-5274 Evening Phone: 651-357-4958 <br />Title and functional responsibility with regard to the event: <br /> <br />Day <br /> <br />Page 1 of 10 <br /> <br />41j <br />