Fillable Special One Day License Application Fillable PDF (Town of Douglas)

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Special One Day License Application Fillable PDF (Town of Douglas)

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TOWN OF DOUGLAS
SPECIAL ONE DAY LIQUOR LICENSE
APPLICATION
MGL c138(14), and 204 CMR 7.00
Date:
Name of Applicant:
Business Name:
Mailing Address:
Event Information:
Event / Liquor Manager:
Date of Event:
Time of Event:
* Attach floor plan: Copy of the blue prints or hand drawn floor plan, drawn to scale, of the proposed premises.
Event Manager Information:
* Manager must fill out CORI form - see checklist for instructions.
Local Licensing Authorities may issue a special license for the sale of wine / or malt beverages to a responsible
manager of any indoor or outdoor activity or enterprise (for profit or non-profit). Special licenses for the sale of all
alcoholic beverages may be issued to non-profit organizations only.
# of Attendees:
Server:
Persons holding a special license must purchase alcoholic beverages from a licensed wholesaler / importer,
manufacturer, farmer-winery, farmer brewery or special permit holder. A person holding a Section 14 license cannot
purchase alcoholic beverages from a package store. See ABCC or Town Website for more information.
TIP Certification Information - Per the Town of Douglas Training Intervention Program (TIP) Policy, list all
individuals who will be serving alcohol with the training expiration. Attach copies of all certificates to the application.
Server:
Server:
Expiraton Date:
Expiraton Date:
Expiraton Date:
* List additional names and expiration dates on a seperate page and attach to the application.
Pursuant to MGL c62C(49A), I certify under the penalties of pergury that, I have filed all state tax returns and paid all
state taxes required under law. I further understand that each representation in this application is material to the
determination of the application and state under perjury that all statements and representations therein are true.
Signed By
Title
Date:
Premise
Description
FID/ SS #:
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Special One Day License Application Fillable PDF (Town of Douglas)

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Completed 14 July 2020

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