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Application for Temporary Liquor License <br />Please check all of the following that apply: <br />Type of License: <br />On Sale Intoxicating Liquor (One to Four Days) <br />• Spirits/Liquor <br />* Wine (Up to 14% alcohol) <br />❑ Consumption & Display (Setup) (One Day) <br />❑ 3.2% Beer On Sale (One to Four Days) <br />❑ Off Sale - Wine Auction (Check with State <br />Gambling Division) <br />Fee: _ $25.00 <br />Date Paid: L QQ LLL <br />Receipt #: CAc _ Go 3 sci <br />e of Organization: 9 <br />:Club <br />❑ Charitable <br />❑ Religious <br />❑ Other Nonprofit <br />❑ Political Committee <br />❑ State University <br />Date(s) liquor will be served and/or sold. P — ! .-- <br />Location liquor will be served and/or sold: _ L16_ (Z..) e Or. „ <br />Please describe the social event sponsored by the licensee: i �L <br />1. Name of Organization: <br />2. Name of Applicant: (r,, V <br />3. Contact Information: _ 41 Sar -l'– 61W Thom) <br />4. Type of event: –S - <br />5. Name of the event: Ae-l� 40d AW <br />L(CP4 <br />6. Hours of the event: <br />7. Number of guests (approximately): _ <br />8. Who will be serving the liquor? <br />9. Will this event be open to the general public? Yes ❑ No <br />10. Is this event by invitation only? ❑ Yes do <br />11. Are tickets sold for admission to the event? X Yes ❑ No <br />12. If tickets are sold, for what purpose are net profits used?- �ee ZVt m colt <br />13. If tickets are sold, is liquor included with the price of the ticket? X <br />Yes <br />Page 2 <br />