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1 CITY OF DOUGLAS ONE DAY MALT BEVERAGE PERMIT APPLICATION Authorizes the sale of malt beverages only by any responsible person or organization. NO spirituous or fermented alcoholic products may be sold or offered with this permit. If application is for the SALE of malt beverages, Wyoming State Law requires applicant to collect and remit sales tax. A Temporary Business Operations application from the Department of Audit is attached and must be remitted to that department. For more information regarding sales tax, contact the Department of Audit/Excise Tax Division at [PHONE REDACTED] or visit http://revenue.wyo.gov . INFORMATION REGARDING APPLICANT: Full Name: Address: City: State/Zip: Phone number: Cell: Organization Name (if applicable): Primary contact person (if different from applicant): Phone number(s): Cell: INFORMATION REGARDING EVENT: Type of event to be held: Approximate # of people attending: Date permit will be used: Hours of permit: to (am/pm) Location/premise where permit will be used: Define Boundaries of permit area (attach map and diagram showing consumption and dispensing areas: Security/control/supervision measures to be used in addition to required wrist bands (e.g. ID scanner; other means to check IDs; monitoring in place; limited number of entrance/exits; clear cups; etc.): Any person, organization, or licensee who is issued a permit hereunder, shall by operation of the issuance of the permit, indemnify and hold the City, its employees, agents and representatives, including members of the City Council in their representative capacities, harmless from any liability, loss or damage which may be incurred as a result of claims, demands, costs, or judgments arising out of, connected with, or concerning the issuance, use or existence of the permit. SIGNATURE OF APPLICANT DATE OF APPLICATION FOR OFFICE USE ONLY Permit Fee Receipt # Date of Approval Deposit Fee (Required if City property) Date Received License # Issued NOTE: DEPOSIT IS REFUNDED UPON CLEANING OF LOCATION Date verified with Public Works: By Date deposit refunded: By ---PAGE BREAK--- 2 STAFF COMMENTS & APPROVALS CITY ADMINISTRATOR ADMINISTRATIVE SERVICES DIRECTOR CITY CLERK CHIEF OF POLICE PUBLIC WORKS DIRECTOR COMMUNITY DEVELOPMENT/PLANNING DIRECTOR ---PAGE BREAK--- 3