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CentervilIe Special Event Permit Application 1. TITLE, PURPOSE, AND BRIEF DESCRIPTION OF EVENT: Egg Hunt CONTACT PERSON: Greg Kieselhorst TELEPHONE: 612-221-9122 OR 651-653-1833 New Application: X Renewal of or Chang 2. IDENTIFYING INFORMATION: Attach a written communication from the organization(s) in whose name the event will be advertised which authorizes you, the applicant, to apply for this special event permit on its/their behalf. Applicant's Name: _Greg Kieselhorst Address: 7155 Brian Drive Centerville, MN 55038 Mailing Address: Same as above Affiliation: Centerville Lions Club Day Phone: _612-221-9122 Evening Phone: Emergency Phone: 612-221-9141 Title: Lions Secretary 651-653-1833 3. EVENT PRINCIPALS: Following, please list the names, addresses and telephone numbers of all the principals involved in any of the proposed special event. Include professional event organizers, event promoters, [mancial underwriters, commercial sponsors, charitable agencies for whose benefit the event is being produced, the organization(s) in whose name the event is being advertised, and all others administratively, financially and organizationally involved as principals in the production of the proposed special event. Make additional copies of the following as needed to include as of the principals involved in the proposed special event. Name: Centerville Lions Club Organization/Business! Agency! Affiliation: Volunteer Organization Is this a non-profit organization? X Yes No If you are making application under non-profit status, proof of non-profit status must be attached to this application * Should be on file with the City of Centerville from the Mirmesota Secretary of State, if not it will be provided. Mailing Address: Same as above Day Phone: Same Evening Phone: Same Title and functional responsibility with regard to the event: Centerville Lions Secretary. As part of said duties, event permits and Lion insurance add-ons etc. Page 1 of 10 ffi