Application Form For State Of Illinois Special Use Permit Liquor License Page 2
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34. SPECIAL EVENT DETAIL
A.
Provide the date(s) and time(s) that the event will be held. When you receive your printed license certificate
from the Commission, times will be listed in military time; i.e. “0200” = 2AM, “1200” = noon”; “2400” = mid-
night; etc.
Provide the address/location of the event. If an address is not available, provide specific instructions to
B.
enable our investigators to find the event.
C.
Provide the name/type of the event; i.e. neighborhood festival, Octoberfest, fish fry, etc.
D.
Determine the total number of event themes/event types for which approval is requested. Use a separate
application for each event theme/event type.
E.
Determine the total number of calendar days covered by the event. If your neighborhood festival runs for 21
days, you will be required to fill out two applications and pay two fees (2 x $100 = $200). If you have a fish fry
each Friday for two successive Fridays (8 days), you are only required to fill out a single application and pay
a single application fee ($100) since the theme is identical, the event is for more than one day, and the total
duration is less than 15 consecutive days.
DATE OF EVENT
TIME
DATE OF EVENT
TIME
EVENT ADDRESS
EVENT THEME
FROM
FROM
TO
TO
( CITY/STATE/ZIP )
( TYPE OF EVENT )
(MONTH/DAY/YEAR)
( AM/PM )
(MONTH/DAY/YEAR)
( AM/PM )
5. CORPORATE/ORGANIZATION OFFICER INFORMATION (CHANGES OR ADDITIONS ONLY)
NAME (LAST, FIRST, MIDDLE INITIAL)
HOME ADDRESS
CITY
STATE
ZIP
DATE OF BIRTH
SEX
TITLE/POSITION
AREA CODE/TELEPHONE NO.
SOCIAL SECURITY NO.
% OWNED
(
)
NAME (LAST, FIRST, MIDDLE INITIAL)
HOME ADDRESS
CITY
STATE
ZIP
DATE OF BIRTH
SEX
TITLE/POSITION
AREA CODE/TELEPHONE NO.
SOCIAL SECURITY NO.
% OWNED
(
)
NAME (LAST, FIRST, MIDDLE INITIAL)
CITY
HOME ADDRESS
STATE
ZIP
SOCIAL SECURITY NO.
DATE OF BIRTH
SEX
TITLE/POSITION
AREA CODE/TELEPHONE NO.
% OWNED
(
)
Page 3 of 4
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