Valley County Liquor Catering Permit Form (Page 2 of 2) in pdf

Valley County Liquor Catering Permit Form Page 2

VALLEY COUNTY LIQUOR CATERING PERMIT

Catering permits must be submitted to Valley County Clerk’s office no later than one (1) week prior to the event. Fees and a

copy of the State License must be included. Upon approval the original signed permit must be posted during hours of operation.

EVENT INFORMATION:

Event Name: ________________________________________________________________________

Location address: ____________________________________________________________________

The sponsored event will be open to the organization, group, persons or guests for a period of ____days, not to exceed

three (3) consecutive days, at a fee of twenty dollars ($20) per day.

Date(s):_____________________ Hours of Operation: __________ to__________ Fee: ____________

Applicant’s Name: ______________________________ Phone # (____) _________________________

Applicant’s Signature: ______________________________________ Date: ______________________

STATE LICENSE INFORMATION:

Holder of State License: ________________________________________________________________

Address: ______________________________ City: _________________________ Zip: _____________

Contact Name: __________________________________ Phone # (_____) _______________________

State License # _________________________ Issued Date: __________________

I hereby authorize the use of my State Alcohol License for the above event/applicant.

State Licensee Signature: _____________________________________ Date: ____________________

Unless licensee is disqualified, approval of the permit does certify that the Licensee is entitled to hold and use the

Valley County Catering Permit at the above designated Premises, subject to provisions of the Title 23-I.C.

Approval _________

Disapproval __________

Valley County Sheriff: ____________________________________________ Date: __________________

Attest:___________________________________________________ Date: __________________

Valley County Clerk

219 N. Main Street, PO Box 1350 Cascade, ID 83611 Phone No. (208)382-7100

Valley County Liquor Catering Permit Form Page 2