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Please return to: Town of Minden 1604 Esmeralda Ave. Suite 101 Minden, NV 89423 Phone: [PHONE REDACTED] Fax: [PHONE REDACTED] TOWN OF MINDEN MINDEN PARK APPLICATION AND USE PERMIT This application and deposit must be on file in Town of Minden in order to guarantee facility rental. Name of Organization / Responsible Party Date(s) of Rental Type of Activity to be conducted Phone Number Email Address Mailing Address City and State Zip Code Physical Address City and State Zip Code Requested opening time Requested closing time Total hours Anticipated Number of People PARK AMENITIES Check all amenities that will be needed for your event: Electricity on at the Gazebo Electricity on at 5th Street Tables Chairs Extra Dumpsters Microphones, If so, how many? iPod Connection For the duration of my event, I would like the Splash Pad to be turned: ON OFF Nature and duration of any amplified sound: What (if any) vehicles will be brought into the park? APPLICANT CERTIFIES RECEIVING THE CVIC HALL POLICIES AND PROCEDURES AND AGREES TO ABIDE BY ALL PROVISIONS THEREOF. APPLICANT/RESPONSIBLE PARTY MUST HAVE A COPY OF THIS APPLICATION DURING THE CVIC RENTAL. Policy Received: Signature of applicant Date For official use only Is the deposit name/address different than above? Yes No Amount of Name on Deposit Check / Credit Card: Address on Deposit Check/CC Billing Address: Calendar Website Sales Receipt Credit Memo Invoice Payment Received Insurance Received Deposit Returned Will the activity involve alcohol consumption? Yes___ No___ If yes, will alcohol be sold? Yes___ No___ If alcohol is to be sold, a permit must be obtained from the Sheriff's Office at [PHONE REDACTED]. Will the activity involve selling food? Yes___ No___ If food is to be sold, please contact the Health Department at [PHONE REDACTED] for permit requirements. Is this event open to the public? Yes No If so, what is the starting time of the event? Is a Flyer available? Yes No Advertise Event on Social Media? Yes No (Facebook and Twitter)