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MyDoc/Facility Use App. FEES Revised 10/14/09 CITY OF LEWISTON, MAINE FACILITY USE APPLICATION COMPLETE FRONT SIDE AND RETURN TO: Lewiston Department of Recreation, 65 Central Ave., Lewiston, ME 04240. WITH $30 APPLICATION FEE -AT LEAST TWENTY-FIVE (25) DAYS BEFORE THE EVENT. Date of (Person or Organization Name) If organization: name, address, telephone number of authorized representative. CHECK Facility: Armory Multi-Purpose Center Event Dates: Event Time: Begin: End: TYPE OF EVENT: (Check as many as are applicable) ____Entertainment ____General Public ____Sporting ____Dance ____Recreational ____Commercial (please specify) Description of Event Purpose of (i.e. fundraising, profit-making) Anticipated Attendance (estimate) Admission Fee/Donation? ___Yes ___No If Yes, specify amount Age Restriction on Admission? ___Yes ___No If Yes, specify age required for admission____ License/Permit Required? ___Yes ___No If yes, specify type (State/Municipal) Name of Licensing Authority i.e. liquor, food USE FEE REQUESTED: Commercial A (revenue producing) Commercial B (non-revenue producing) Non-Profit A (revenue producing) Non-Profit B (non-revenue producing) Exempt (Lewiston non-profit, gov't) Signature of Applicant or Its Authorized Representative Date ---PAGE BREAK--- TO BE COMPLETED BY CITY Acted on by Director Date Referred to Facility Use Review Committee Date ACTION TAKEN: GRANTED GRANTED WITH CONDITIONS DENIED If Granted with Conditions, description of conditions imposed: Security Additional Fees: (state amount and reason)