Fillable Form 2170: Permit Application for a Special Events (Town of Wellington)

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Form 2170: Permit Application for a Special Events (Town of Wellington)

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The Form 2170: Permit Application for a Special Events (Town of Wellington) form is 2 pages long and contains:

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  • 23 check-boxes
  • 43 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Wellington

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In order to qualify for a Special Events Permit, You Must Be Nonprot
and One of the Following (See back for details.)
2. Mailing Address of Organization or Political Candidate
(include street, city/town and ZIP)
3. Address of Place to Have Special Event
(include street, city/town and ZIP)
State Sales Tax Number (Required)
5. Event Manager
Date of Birth
4. Pres./Sec'y of Org. or Political Candidate
Name
Home Address (Street, City, State, ZIP) Phone Number
2170
Malt, Vinous And Spirituous Liquor $25.00 Per Day
NO YES HOW MANY DAYS?
7. Is premises now licensed under state liquor or beer code?
NO YES TO WHOM?
Date
Hours From .m.
To .m.
Oath of Applicant
I declare under penalty of perjury in the second degree that I have read the foregoing application and all attachments thereto, and
that all information therein is true, correct, and complete to the best of my knowledge.
Date
Hours From .m.
To .m.
Date
Hours From .m.
To .m.
Date
Hours From .m.
To .m.
Date
Hours From .m.
To .m.
Title
Report and Approval of Local Licensing Authority (City or County)
The foregoing application has been examined and the premises, business conducted and character of the applicant is satisfactory,
and we do report that such permit, if granted, will comply with the provisions of Title 44, Article 5, C.R.S., as amended.
THEREFORE, THIS APPLICATION IS APPROVED.
Signature
Local Licensing Authority (City or County) Telephone Number of City/County Clerk
Title
List Below the Exact Date(s) for Which Application is Being Made for Permit
Signature
Total
(Instructions on Reverse Side)
DO NOT WRITE IN THIS SPACE
Liquor Permit Number
Type of Special Event Applicant is Applying for:
LIAB
City
County
6. Has Applicant Organization or Political Candidate been
Issued a Special Event Permit this Calendar Year?
8. Does the Applicant Have Possession or Written Permission for the Use of The Premises to be Licensed? Yes No
Fermented Malt Beverage $10.00 Per Day
2110
DO NOT WRITE IN THIS SPACE - FOR DEPARTMENT OF REVENUE USE ONLY
Liability Information
StateLiability DateLicense Account Number
1. Name of Applicant Organization or Political Candidate
-750 (999)
Date
Departmental Use Only
Social
Fraternal
Patriotic
Political
Athletic
Chartered Branch, Lodge Or Chapter
Of A National Organization Or Society
Religious Institution
Philanthropic Institution
Political Candidate
Municipality Owning Arts Facilities
DR 8439 (12/21/18)
COLORADO DEPARTMENT OF REVENUE
Liquor Enforcement Division
(303) 205-2300
•
$
Date
Application for a Special Events
Permit
(44-5-102 C.R.S.)
A Special Event Permit issued under this article may be issued to an organization, whether or not presently licensed
under Articles 4 and 3 of this title, which has been incorporated under the laws of this state for the purpose of a social,
fraternal, patriotic, political or athletic nature, and not for pecuniary gain or which is a regularly chartered branch, lodge
or chapter of a national organization or society organized for such purposes and being non prot in nature, or which is
a regularly established religious or philanthropic institution, and to any political candidate who has led the necessary
reports and statements with the Secretary of State pursuant to Article 45 of Title 1, C.R.S. A Special Event permit may
be issued to any municipality owning arts facilities at which productions or performances of an artistic or cultural nature
are presented for use at such facilities.
If an event is cancelled, the application fees and the day(s) are forfeited.
Application must rst be submitted to the local licensing authority (city or county) at least thirty (30) days prior to the event.
The premises to be licensed must be posted at least ten (10) days before a hearing can be held. (44-5-106 C.R.S.)
An approved application must be received by the liquor enforcement division at least ten (10) days prior to the event.
Check payable to the Colorado Department Of Revenue
Application Information and Checklist
The following supporting documents must be attached to this application for a permit to be issued:
Appropriate fee.
Diagram of the area to be licensed (not larger that 8 1/2" X 11" reecting bars, walls, partitions, ingress, egress and dimensions.
Note: If the event is to be held outside, please submit evidence of intended control, i.e., fencing, ropes, barriers, etc.
Copy of deed, lease, or written permission of owner for use of the premises.
Certicate of good corporate standing (NONPROFIT) issued by Secretary of State within last two years; or
If not incorporated, a NONPROFIT charter; or
If a political Candidate, attach copies of reports and statements that were led with the Secretary of State.
DR 8439 (12/21/18)
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Form 2170: Permit Application for a Special Events (Town of Wellington)

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Completed 17 July 2020

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