Laserfiche WebLink
APPLICATION AND PERMIT <br />FOR A 1 TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />(Organization or location limited to 3 permits in a 12 month period) <br />• . +.A YA,401T411VY1 <br />NAME OP ORGAt+&IZAfl N <br />L, Kin LAk -t,'S" Li dly <br />DATE ORGANIZED <br />'3^ (9- 7-3 <br />TAX EXEMPT NUMBER <br />e "-k^ 730(.039.. <br />S'1TtEET ADDRESS <br />84.2 t'1 a. pt_e T. <br />CITY <br />t_, tau L4 tc cf <br />STATE <br />IM K1 <br />ZIP CODE <br />jb ! ¢- <br />NAME OF PERSON' MAKING APPLICATION <br />ii-A.,.,,. Zr- P . s 7 / s/s's <br />BUSINESS PHONE <br />(fr) 784. • 7522 <br />HOME PHONE <br />6 9) /80 ^ 4974 - <br />DATES LIQUOR MIX HE SOLD tl to 4 days), <br />a : i.42-‘,:1 - <br />TYPE OF ORGANIZATION <br />,_ CLUB n CHARITABLE ❑ RELIGIOUS 0 OTHER.NON ROFTT <br />OR , NAME eS <br />Gvt s ,( <br />ADDRESS <br />o2 f <br />ADDRESS 7.�r3 <br />57 <br />t <br />IkpLe Sr. Lote LA r...c• , py1J <br />, /�/ CJC ■ c LA-r\<- <-'e - <br />1L <br />ORQA TIOONNOFFFFICE1t'S3,tt�Iti <br />t_ tA) lete C Sv.c� <br />ORGANIZA► ON OFFICER'S NAIA. <br />COLc•e—. t.J:`.t C Tied - S) <br />ADDRESS <br />7?, <br />Of re r • c L.A.-1 ,a- L. L. <br />Location where license 1,411 is used. If an oltdoor arts, desen <br />L_, L . N.IKt <br />wt4 <br />Will the applicant -contact intoxicating liquor services? If so, giro die name eed ogress of dreLignor lieu providing the service. <br />WiII the applicant carry liquor liability insuranco? if so, the camas' s name and wan of coverag <br />(NOTE: Inroranoe is not nttmdatory) �� <br />APPROVAL <br />APPLICATION M(JST BB APPROVED BY CITY OR COUNTY BEFORE. SUBMITTING TO LIQUOR CONTROL <br />CITY/COUNTY <br />CTTY 1 hE AMOUNT <br />DATE FEE PAID <br />SIGNATURE CITY CLERK OR COUNTY OFFICIAL <br />DATE APPROVED <br />LICENSE DATES <br />APPROVED LIQUOR CONTROL DIRECTOR. <br />NOTE: Do not separate these two parts, send both parts to the address above and the orlghtnl signed by tbls dk► ilon • <br />will be returned as the license. Submit to the Clty or County at least 30 days Worn the event. <br />PS-09079(8/95) <br />