Laserfiche WebLink
<br /> <br />J 880 : ~ i ~l i r; ... '" t r C ct. {'t-~ " t C T'Ui Uc I .-, ",_ 5 5i) 3 S <br /> <br />'EstaLJlL,;frCii 18_~7 <br /> <br />: t'; ~ 1 1 ..j ~ ," L .~ ~ :! _ ~ :2 ... T: l.r ! ~ 5 1 .' ~ ~ ,'" L, ",.. c; 2 () <br /> <br />CITY OF CENTERVILLE <br />APPUCATION FOR A 1 TO 4 DAY TEMPORARYIEVENT 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 />Name of Organization Date Organized <br />L<r~(i;~'~ L-t~~~" 1<9-'74- <br />Street Address City <br />7,?:; '3',2.t~ ~v~ C-€.tJ~i2-v \~ <br />Name of Person Completing Application Business Phone <br />~ b ~le~e\...r~~ b i -2-- ~2-f ~ 9t 7-2- <br />Dates Liquor Will Be Sold (1 to 4 days) Type of Organization <br />2-- ~.,- o~ &>~ 2- - J ~ - D g 0 CLUB 0 CHARITABLE 0 RELlGIOU OTHER NON- pW t <br />Organization Officers Name Address <br />:....J or4 L-A ~ ....J Dr-l ~ 7 <br />Organization Officer-s Name Address <br />bi2eb. I?-\C~a;t.-~ ,,")\~t; 'd-'2-tJ\,..J 'iY~\\Jli" ~,~:~ <br />Organization Officer's Name Address <br />i~ -nt, €~....l bh 75 '\e~ \., <br />Location where license will be used. If an outdoor area, describe: <br />L~~I~'H'~ t..-A"-tS l--\C>t-1~ \~ Pt~.-ot~'- L-~~c:-.YI <br /> <br />Tax Exempt Number <br />2-~'-739 '5 r::R <br />State Zip Code <br />ft\,..J ~?'? &>'3 9 <br />Home Phone <br />hF3\--~7>'-1 ~3 <br /> <br /> <br />\Je. ut-JT~~\~ <br /> <br />l.-\~~ ~~ <br /> <br /> <br />If SOl give the name and address of the <br /> <br />Will the applicant carry liquor liability insurance? If so, the carriers name and amount of <br />covera e. \? ~ ~:;2-e?-,;~y 'w rr-~ \f: ..~ ~~~\J,~ <br /> <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY COUNCIL PRIOR TO SUBMISSION TO LIQUOR CONTROL <br />CITY OF CENTERVILLE DATE APPROVED <br />FEE AMOUNT $ LICENSE DATES <br />DATE FEE PAID <br /> <br />City Clerk <br />NOTE: Submit to the City 0 <br /> <br /> <br />Signature of Applicant: <br /> <br />~I <br />