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<br /> <br />1880 fMmn$tnlt . CtfJ~ MX. 5SG_19 <br />j6..Q142.9-3232 . .'Tm:.!6S1.1 429-R62ff <br /> <br />CITY OF CENTERVILLE <br />APPLICATION FORA 1 TO 4 DAY TEMPORARYIEVENT ON SALI! UQUOR UCEN8E <br />(Otganlzetfon or locatiOn IImIled to 3 pennlts In a 12 month period) <br /> <br />Type or Print h\formatiOn <br /> <br /> <br />OTHER NON- <br /> <br />WiD the applIc:ant contrect for lfi\o)CJC8ting Dqwr seMces? If &D, give the name and address of the <br />IICJ8nS9 Ute servtce. ~ <br /> <br />Witt the applicant cany lIquor liability 1nsUraI1C87 If so. the carrier's name and amount of <br />. It- -~ ~ <br /> <br /> <br /> <br />APPROVAL <br />APPUCA110Jt MUST IE APPROVED BY' crrt COIINCP PRIOR 108h.'1I.<lOU)N TOI.IQUGR COJfI'ROL <br />crrv OFCENTERVlUE DATE~VED <br />FEE AMOUNT $. UCEN8E DATES <br />DATE FEE PAID <br /> <br />. Clerk <br />NOTE: SUbmit to the CIty <br /> <br /> <br />prior to event. <br /> <br />SIgnatUre of AppIlcant <br /> <br />33 <br />