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STATE OF COLORADO l tyrotet Struve <br /> OEMA TFMEN?OP REVENUE C1Md+eeo EON? <br /> • <br /> LIQUOR ENFORCEMENT DIVISION /839-3741 <br /> i . <br /> • <br /> J <br /> ICEN>tI <br /> UMIIPi <br /> APPLICATION FOR A SPECIAL EVENTS PERMIT _ <br /> INSTRUCTIONS: This application.and all apptkable fats and attachments frost FIRST SE PILED WITH AND APPROVED BY THE <br /> LOCAL LICENSING AUTHORITY NOT LESS THAN THIRTY DAYS PRIOR TO THE EVENT.Then mail the completed and approved <br /> epptiretian to Colorado Department of Re+r.nus, LIQUOR ENFORCEMENT DIVISION,State Capitol Annex, 1375 Sherman&r..t oust, <br /> to arrive no later then TEN(101 DAYS PRIOR TO THE DATE OF THE EVENT. <br /> Whit type of permit are you applying fort --- <br /> FERMENTED MALT BEVERAGE(3.2 Beer Only)(State License Fee-310.00 Per day)" �. <br /> CI MALT,VINOUS AND SPIRITUOUS LIQUOR(State License Foot-$28.00 per day)" <br /> "Your local licensing authority will Indicate the amount of tht:r license fat. <br /> The undersigned hereby makes sppllatian for a state license as indicated above,under the provisions of Title 12.Article 48.CRS 1973 as <br /> amended.and for that purpose makes the following answers to the questions contained in this application. Every appticabls Question must <br /> be answered.My false answer or sutermnt mad.by the applicant herein or in an attachment hereto COf Uitutee perjury and the person <br /> mating such false statements subjects any license issued herein to revocation. <br /> - <br /> ALL ANSWERS MUST OE PRINTED IN SLACK INK OR TYPEINRITTEN <br /> t. NAME OP APPLICANT: CORPORATION OR ORGANIZATION <br /> + <br /> 2.TRADE NAM Of anyy: TEL PHONE NO O V NT MAN • <br /> 7.ADDRESS OF PLA TO NAVE TEMPORARY S POSIT:(Errsct lotatlon N premises trivet be!even.OHra sns.r and unmoor,wrtan aWs:o?.. If piece u bit <br /> Heene.d H Iocatsd in I towel et Pyre dletrkt Who.It Is NnpOMFbte to tire street ar+a rwfrdrer.the kit and block numbs.or pert of a.ctlart*t..lseated mum <br /> Os glum.At • f aril ,"Xt t^' wlnwrn)oho t • et .:II .r a. ) <br /> Lir • /1 . . our F • .1 <br /> 4 Att.IM° A••RISS(Strafe and rwmMrl. C TY OR TOWN: ZIP ODI: <br /> C i • >i-TAT • <br /> • rwRir nave tl mm*ender the State Liavor or/Mr Cods?If aura 1r"YES to*iMm 1a tM flame,Famed? <br /> N}C . <br /> Rya& •r 4. cosy five"'phial <br /> of tMssr,I s,for wt+teA this he011cat+M h raga,eithig by - • •,. .. •• • • .• t <br /> 1!YES I ell�� .elf"NO" ospiaio. <br /> 7.The I ACT alt w(s/for whisk spplltatlef Is brine mom for porrnit.(t **Owe for more than too succeseMS fors.use addrtlon.l apps stall n(.)) <br /> PROM(DSS.y (Move r^ �J: 0 Weird: eel <br /> FROM(Dote): Manny: TO(Date!: (Howl: <br /> O.Is sS01Gaa 1 ypnllstt*w h‘coro rsfed arid..trwa lest%st;Ns stew for 1140,44isi of•social.fralsrnsl,patriotic,psrfitical.or warns wssur.,net for Donate ry <br /> 100.or le It a regularly~wed breath.bolos. r*Now N a nation&NsanetstIen M SeeetY reamed for loth ourposss,steno marl fraflt It metro:sr <br /> M It a ronohisrs or phlIewtlwools Instifnttonl <br /> . a ■NO If"NO".eapt.lw: e. ls.L1 :...a ls,ts •, •-f i► • a 1 <br /> C.If tem applISant M eve or otIsstlon irees,•NOraad in Ws state to.•.nog-paewl.ry•.(noi protItl Depose.snsvett Isle(0)and(c).Auto vox,...Condisaug <br /> Ca)- OrMrus*f wMS0 the laws of de)awe of: Comoro: <br /> Colorado BOULDER <br /> Cs).Coroolow the faflOwina Fw detsu: <br /> II T411; .. E: MOMi AGO ■ . TY& TAT aI TM DA r <br /> PRESIDENT .ITTSr Zi {„11 u > (jj,eoLV a if (1-ssz <br /> VICEPRMSIDEMT a t. . . 33 R.-r- • ! + • • <br /> IIMPEr 4 <br /> v <br /> ► r ' I�*w 1 1.. / 1 • /1/"" <br /> r8s wimwnws 1411.r _V <br /> 10.Afa the erirtlwa Iw»»nw0 fasurtiss at appf,tae+r°romne-Meow ntadequate for serving mstnbers or Ey..te of the o.ealuzat.on by►Basal of R <br /> Nisciet'vent rrilf d,it achodu►.dr <br /> Oyes Ono <br /> 014I...4311(Rev.4/soy r Coatistusil On Swat _ w A <br />