IN ORDER TO QUALIFY FOR A SPECIAL EVENTS PERMIT, YOU MUST BE NONPROFIT
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 12, Article 48, 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 Size)
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 (3.2 Beer) $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
Department 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 (06/28/06)
COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
1375 SHERMAN STREET
DENVER CO 80261
(303) 205-2300
•
$
DATE
APPLICATION FOR A SPECIAL
EVENTS PERMIT