Form Se-2 - Special Event License Application Addendum
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3VIRGINIA DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL
SPECIAL EVENT LICENSE APPLICATION ADDENDUM
NOTICE TO SPECIAL EVENT LICENSES APPLICANTS
Board regulations require persons in charge of public events to report to the Board the income and
expenses associated with the event, when the licensee engages another person to organize, conduct
or operate the event on behalf of the licensee. The purpose of this form is to determine whether a
report of income and expenses will be required in connection with the license applied for.
Applicant name ______________________________________ Date of event__________________
SAME AS APPEARS ON SPECIAL EVENT LICENSE APPLICATION
Organization _________________________________________ License #____________________
NAME OF NONPROFIT ORGANIZATION OBTAINING LICENSE
Address_____________________________________________Telephone____________________
City____________________________________State__________________Zip_________________
Please answer the following questions:
1.
Will any person, organization, or business, other than the nonprofit organization
applying for this license, receive any compensation or payment for organizing,
operating, or conducting the event for which this license is requested?
[ ] YES
[ ] NO
2.
If the answer to question 1 is YES, will alcoholic beverages be sold to members of the
general public?
[ ] YES
[ ] NO
Applicant signature_________________________________________Date____________________
ATTACH THIS ADDENDUM TO THE SPECIAL EVENT LICENSE APPLICATION
If the answer to both questions 1 and 2 is YES, the applicant must (1) attach to the application a copy
of any agreement between the licensee and the person engaged to organize, operate, or conduct the
event, and (2) if the license issued, complete a Statement of Income and Expenses for Special Event
Licenses form provided with the license and return the completed form to the issuing regional office
within thirty (30) days after the date of the event.
VA ABC Abingdon
VA ABC Alexandria
VA ABC Charlottesville
VA ABC Chesapeake
VA ABC Fredericksburg
(Satellite of Roanoke)
6308 Grovedale Dr.
900 Natural Resources Dr.
1103 S. Military Hwy.
Lee Hill Building II
102 Abingdon Place
Alexandria, VA 23310
Suite 700
Chesapeake, VA 23320
10304 Spotsylvania Ave.
Abingdon, VA 24211
Ph: 703-313-4432
Charlottesville VA 22903
Ph: 757-424-6700
Suite 101
Ph: 276-676-5502
Fax: 703-313-4444
Ph: 434-977-2974
Fax: 757-424-6744
Fredericksburg, VA 22408
Fax: 276-676-5549
Fax: 434977-4772
Ph: 540-322-5440
Fax: 540-891-3153
VA ABC Hampton
VA ABC Lynchburg
VA ABC Richmond
VA ABC Roanoke
VA ABC Staunton
4907 W. Mercury Blvd.
20353 Timberlake Rd.
Boulders II
2943 Peters Creek Rd. NW
460 Commerce Rd
PO Box 5226
Suite A
7400 Beaufont Springs Dr.
Suite D
Staunton, VA 24401
Hampton, VA 23605
Lynchburg, VA 24502
Suite 101
Roanoke, VA 24019
Ph: 540-332-7800
Ph: 757-825-7830
Ph: 434-582-5136
N. Chesterfield, VA 23225
Ph: 540-562-3604
Fax: 540-332-7814
Fax: 757-825-7884
Fax: 434-582-5140
Ph: 804-213-4620
Fax: 540-562-3612
Fax: 804-323-1055
Form SE-2
Rev. 08/02
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