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Application For Temporary Expansion Of Licensed Premises Form - License Division - City Of Independence, Missouri

LICENSE DIVISION - CITY OF INDEPENDENCE, MISSOURI

111 East Maple, Independence, Missouri 64050

(816) 325-7079

Date

APPLICATION FOR TEMPORARY EXPANSION OF LICENSED PREMISES

The undersigned (individual owner) (partner) (Managing Officer) hereby make application for a Temporary Expansion

of Licensed Premises.

Name of Owner/Partner/Managing Officer

Address

Name of Business Applying for Temporary Expansion

Business Address

Date(s) for which temporary expansion is being requested

Name of event for which temporary expansion is being requested

Total dimensions of proposed expanded area in which alcoholic beverages will be dispensed

If expansion is to be into parking lot area, give brief description of type of fencing to be used and the method to be used

control ingress and egress into the expanded area:

I, (please print)

of lawful age, and duly sworn upon my oath, swear that the answers and information given in this application are true and complete

to the best of my knowledge and belief.

Owner/Partner/Managing Officer

Subscribed and sworn to before me this

day of

, 20

My Commission expires:

Notary Public

Application For Temporary Expansion Of Licensed Premises Form - License Division - City Of Independence, Missouri