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1 CITY OF DOUGLAS ONE DAY MALT BEVERAGE PERMIT APPLICATION INFORMATION REGARDING APPLICANT: Full Name: Organization Name (if applicable): WY Sales Tax License number: Food Permit number (location specific): Address: City: State/Zip: Phone number: Cell: Primary contact person: Phone number(s): (If different from applicant) INFORMATION REGARDING EVENT: Type of event to be held: Date permit will be used: Hours of permit: Number of people: Location/address of event premise: Define Boundaries of permit area and attach a map and diagram showing enclosed 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.) NOTE that proof of alcohol server training certification is required for the permit holder: 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 NOTE: DEPOSIT IS REFUNDED UPON CLEANING OF LOCATION Permit fee paid - $25 (check # or cash) Receipt Date received: Date of approval: License # Issued: Deposit fee - $100 (check # or cash): (Required if using City property) Condition of location (verified w/Parks) – Date/verified by: Deposit return date: Manner of return/returned by: • 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. • Wyoming State Law requires applicant to purchase all malt beverages to be sold from a licensed distributor, and requires applicant to collect and remit sales tax. • If you do not already have a Wyoming sales tax license, a Temporary Business Operations application from the Department of Audit (attached) must be attached as well as remitted to the Dept. of Audit. For more information regarding licensed distributors, contact the Wyoming Liquor Division at [PHONE REDACTED], 6449, or 7233. For more information regarding sales tax, contact the Department of Audit/Excise Tax Division at 307- 777-5543 or visit http://revenue.wyo.gov . • Please submit your application to the City Clerk a minimum of 14 calendar days prior to your event to ensure adequate time for processing and mailing. Required permit fees are non-refundable, even if a permit is not approved; deposit fees, if required, are refundable. SIGN ---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 SIGN SIGN SIGN