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<br />::ZoO y <br /> <br /> <br />tervi[[e <br />1:sfa6[isfrd 1857 <br /> <br />1880 9Yfain Street . CentervifCe, I}.{g( 55038 <br />(651) 429-3232 .:TO:;( (651) 429.8629 <br /> <br />CITY OF CENTERVILLE <br />APPUCATION FOR A 1 TO 4 DAY TEMPORARYIEVENT ON SALE UQUOR UCENSE <br />(Organization or location limited to 3 permits in a 12 month period) <br /> <br />Type or Print Information <br /> <br /> <br />C~~ <br /> <br />Business Phone <br />""S/- '15$'- ?,;(s~ <br />Type of Organization <br />o CLUB 0 CHARITABLE t(RELlGIOU <br />Address <br />~ <br />Address <br /> <br />Tax Exempt Number <br />c:< 5 ~ ~o <br />State Zip Code <br />UN' .5 5~3~ <br />Home Phone <br /> <br />Date Organized <br />a(,~dt <br /> <br />o OTHER NON- <br /> <br />Organization Officer's Name <br /> <br />Address <br /> <br />Loca ion where license will be used. If an outdoor area, describe: <br /> <br /> <br /> <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY COUNCI. PRIOR TO SUBMISSION TO LIQUOR CONTROl. <br />CITY OF CENTERVILLE DATE APPROVED <br />FEE AMOUNT $ LICENSE DATES <br />DATE FEE PAID <br /> <br />Cit Clerk <br />NOTE: Submit to the City of Centerville at least thirty (30) days plior to event. <br />Signature of Applicant: (;{tl1~ ~ 7JJ ;tt; to - ~ r j) ~c <br />VJ..tf) ~L \.A.) o..Uv.L ~. <br /> <br />~~ <br />