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24 HOUR/DAILY ALCOHOLIC BEVERAGE PERMIT APPLICATION To be completed by City/County Clerk Date filed with clerk: Local Permit Total Permit Fee: (Permit fee per day x number of days) Applicant: Business/Trade Name (DBA): Contact Person: Phone: Address: City: _ State: Zip: Date(s) of Event through Event Name: Event Location: FILING IN (CHOOSE ONLY ONE) FILING AS (CHOOSE ONLY ONE) CITY INDIVIDUAL CORPORATION PARTNERSHIP LTD PARTNERSHIP COUNTY LP/LLP ORGANIZATION LLC OTHER TYPE OF PERMIT (CHOOSE ONLY ONE) MALT BEVERAGE PERMIT $50 CATERING PERMIT $50 MANUFACTURER’S OFF-PREMISE PERMIT $50 (W.S. 12-4-502(a) / W.S. 12-2-201(b)) (W.S. 12-4-502(b)) (W.S. 12-2-203(g)(ii)) Malt beverage permit applicants receiving anything of value (i.e. money, goods and or services from any industry representative must answer the following: (W.S. 12-5-402(a)) For currently licensed Retail or Resort license holders only For the sale of the manufacturer’s own Wyoming manufactured products only Licensing Authority that issued Satellite Permit OPEN CONTAINER PERMIT * $50 MALT BEVERAGE PERMIT FOR MICROBREWERIES $50 (City Ordinance 3-2-8) (W.S. 12-4-502(a)) Nonprofit corporation under the laws of Wyoming? Yes No (*Permit requires Council approval if in conjunction with Street Closure Request and/or at City Park (located between Sheridan Ave and Beck St.) For the sale of the microbrewery’s own Wyoming brewed products only Tax Exempt Organization under the Internal Revenue Code? Yes No WINERY OFF-PREMISE PERMIT $100 (W.S. 12-4-414(g)) For the sale of the winery’s own Wyoming manufactured products only Licensing Authority that issued Satellite Permit And has the applicant been in continuous operation for not less than two years? Yes No By filing this application, the applicant and their representatives agree to sell alcoholic beverages and operate under the requirements of all applicable Wyoming state and local laws and rules, and submit any required sales tax and reports. Under penalty of perjury, and the possible revocation or cancellation of the permit, I swear the above stated facts, are true and accurate. / / Applicant Signature Printed Name Date / / Signature of Licensing Authority Official Date ---PAGE BREAK---