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un wvra <br />COLORADO DEPARTMENT OF REVENUE <br />LIQUOR ENFORCEMENT DIVISION <br />1376 SHERMAN STREET <br />DENVER CO 80261 <br />(303) 205-2300 <br />21 <br />APPLICATION FOR A <br />SPECIAL EVENTS PERMIT <br />IN ORDER TO QUALIFY FOR A SPECIAL EVENTS PERMIT, YOU MUST BE NONPROFIT <br />AND ONE OF THE FOLLOWING (See back for details.) <br />✓ CHECK ONE: ❑SOCIAL ❑CHARTERED BRANCH, LODGE OR CHAPTER <br />OF A NATIONAL ORGANIZATION OR SOCIETY <br />❑ FRATERNAL ❑RELIGIOUS INSTITUTION <br />12 PATRIOTIC ❑PHILANTHROPIC INSTITUTION <br />❑POLITICAL ❑ POLITICAL CANDIDATE <br />❑ATHLETIC ❑MUNICIPALITY OWNING ARTS FACILITIES <br />LIAB TYPE OF SPECIAL EVENT APPLICANT IS APPLYING FOR: <br />2110 ❑ MALT, VINOUS AND SPIRITUOUS LIQUOR $25.00 PER DAY <br />2170 FERMENTED MALT BEVERAGE (3.2 Beer) $10.00 PER DAY <br />1. NAME OF APPLICANT ORGANIZATION OR POLITICAL CANDIDATE <br />2. MAILING ADDRESS OF ORGANIZATION OR POUTICAL CANDIDATE <br />(include street, city/town and ZIP) <br />4. PRESJSEC'Y OF ORG. or POLITICAL CANDIDATE <br />5. EVENT MANAGER <br />6. HAS APPLICANT ORGANIZATION OR POLITICAL CANDIDATE BEEN <br />ISSUED A SPECIAL EVENT PERMIT THIS CALENDAR YEAR? <br />❑ NO ❑ YES HOW MANY DAYS? <br />Date <br />Hours From <br />To <br />.m. <br />.m. <br />Date <br />Hours <br />From <br />To <br />.m. <br />.m. <br />:; .F8fR1 <br />LOCAL LICENSING AUTHORITY (CITY OR COUNTY) <br />❑ CITY <br />❑ COUNTY <br />SIGNATURE <br />> DO'NOT WRITE fN T# ISs SPAC <br />LIQUOR PERMIT NUMBER <br />3. ADDRESS OF PLACE TO HAVE SPECIAL EVENT <br />(include street, city /town and ZIP) <br />OMEADDRESS (Sheet, Glty State. Z13 <br />7. IS PREMISES NOW LICENSED UNDER STATE UQUOR OR BEER CODE? <br />❑ NO ❑ YES TO WHOM? <br />8. DOES THE APPLICANT HAVE POSSESSION OR WRITTEN PERMISSION FOR THE USE OF THE PREMISES TO BE UCENSED? ❑ Yes ❑ No <br />................. <br />Date <br />Hours <br />From <br />To <br />.m. <br />.m. <br />Date <br />Hours From <br />To <br />.m. <br />DO NOT WRITE IN THIS SPACE <br />State Sales Tax Number (Required) <br />li?fE NiJAABE <br />Date <br />Hours From .m. <br />To .m. <br />Oattr an• <br />thereto <br />:aU.IRf in atO <br />SIGNATURE <br />e, correct an complete <br />TITLE <br />::foie <br />1041e <br />DATE <br />R..,PART�4PEQAPPRC3/PiL01=C.. °' <br />AL L�C <br />e:fore DIR <br />ca <br />Trott has 411 e xart'ttne d acid fhe prerrtises bt�slness coildti <br />d we dD report ch at such permit, d granted will cnttipiy wfth the Pr ovisccrls: f <br />'THEREFORE, THIS APPLICATIOI IS <br />aracter of the.apptcartt is satisfac <br />S., as amended <br />TELEPHONE NUMBER OF CITY /COUNTY CLERK <br />TITLE <br />DATE <br />DO NOT WRITE IN THIS SPACE - FOR DEPARTMENT OF REVENUE USE ONLY <br />ORM tiTION <br />(Instructions on Reverse Size) <br />