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McLean County Clerk's Office 115 E Washington Street, Room 102 Bloomington, IL 61701 (309) 888-5190 Fax (309) 888-5932 Contact for liquor licenses: [EMAIL REDACTED] Website: Application for Class E Retailer’s License Pursuant to: McLean County Code For the retail sale of beer or wine for consumption on the premises specified in connection with a one-day special event held by a non-profit organization: Name of Organization: Mailing Address: Telephone Number : ( ) Email Address: Names, Addresses, and Titles of all officers and directors of organization: NAME ADDRESS TITLE Type of Event: Date to be held: Hours: Location: Has your organization obtained a Special Event Permit from the McLean County Building and Zoning Department? (check one) Yes No (If no, a special event permit must be obtained from the McLean County Building and Zoning Department before a Class E Liquor License can be issued.) Nonprofit Organization is a a Corporation OR a Trust? State File Description of the One-Day Special Event: ---PAGE BREAK--- Will food be served or available? (check one) Yes No (If yes, a food permit must be obtained from the McLean County Health Department before a Class E Liquor License can be issued.) Attach to this Application a Certificate of Insurance issued in compliance with Section 160-19E of the McLean County Code. Additional Statements by Applicant: The applicant is not disqualified from receiving a liquor license by reason of any provisions of the laws of the State of Illinois. The applicant is completely familiar with the terms and provisions of Ch. 160 "Alcoholic Beverages", Chapter 216 "Food Service" and Ch. 350 "Zoning" of the McLean County Code. Applicant will obtain a Special Event Retailer's Liquor License from the Illinois Liquor Control Commission. Proof of County approval of the event is required with the State application. The applicant has/ has not made application for a liquor license on the same or other premises which has been either denied, suspended, or revoked. If has, attach a statement as to the date, place, and reasons therefor. IN WITNESS WHEREOF, the undersigned organization has caused the Liquor License Application to be executed in its name by a duly authorized agent of the liquor license holder, attested this of (Exact Organization Title) This application shall be accompanied by $41.00 - $25.00 for the Application and $16.00 Clerk Fee. Make Check payable to McLean County Clerk. Issuance of a County license as a result of this application does not relieve the applicant from obtaining a Special Event License from the Illinois Liquor Control Commission. I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. By checking the box "I agree," I am signing and affirming all content in this application is true to the best of my knowledge and belief. (Applicant Signature) SIGN