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<br />- <br /> <br /> <br />tervi{{e <br />Uta6fi.5fietf 1857 <br /> <br />e <br /> <br />1880 !Main Street . [entemife,!Jvf'}.[ 55038 <br />(G51) 429-3232 . :Fa?C (651) 429-8629 <br /> <br />CITY OF CENTERVILLE .1.","J..Mud >>t~d?I'~ <br />APPLICATION FOR A 1 TO 4 DAY TEMPORARY/EVENT GN 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 <br /> <br />Date Organized <br /> <br />Tax Exempt Number <br /> <br /> <br />e- <br /> <br />City <br />(!dVf/i' v <br />Business Phone Home Phone <br /> <br /> <br />Type of Organization <br />o CLUB 0 CHARITABLE RELlGIOU 0 OTHER NON- <br />Address <br /> <br />Organization Officer's Name <br /> <br />Address <br /> <br />Organization Officer's Name <br /> <br />Address <br /> <br />Location where license will be used. If an outdoor area, describe: <br /> <br /> <br /> <br />insurance? If so, the carrier's name and amount of <br /> <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY COUNCIL PRIOR TO SUBMISSION TO LIQUOR CONTROL <br />CITY OF CENTERVILLE . A. DATE APPROVED <br />FEE AMOUNT $ ..I~.J er LICENSE DATES <br />DATE FEE PAID yv <br /> <br />City Clerk <br />NOTE: Submit to the City of Centerville at least thirty (30) days prior to event <br /> <br />Signature of Applicant: <br />