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CITY OF DOUGLAS MALT BEVERAGE PERMIT APPLICATION Authorizes sale of malt beverages only – No spirituous or fermented alcoholic products may be sold with this permit. INFORMATION REGARDING APPLICANT: Full Name: Organization Name: City: Contact person: Person responsible for identification checks: Security Measures in use: *Note – Wrist bands will be required for event. INFORMATION REGARDING EVENT: Type of event to be held: of people attending: Location/premise where permit will be used: Define Boundaries of permit area (attach diagram): Control/Supervision measures to be taken: Date permit will be used: permit will be used: to 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 ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ ∞ TO BE COMPLETED BY CITY CLERK Permit Fee Receipt # Date of Approval Deposit Fee (Required if City property) Date Received License # Issued ****NOTE: DEPOSIT IS REFUNDED UPON CLEANING OF LOCATION**** Verified with Public Works: Date deposit refunded: By: ---PAGE BREAK--- ****STAFF COMMENTS**** CITY ADMINISTRATOR ADMINISTRATIVE SERVICES DIRECTOR CITY CLERK CHIEF OF POLICE PUBLIC WORKS DIRECTOR COMMUNITY DEVELOPMENT/PLANNING DIRECTOR