Special Events Permit - State Of Alaska Alcoholic Beverage Control Board
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1STATE OF ALASKA
ALCOHOLIC BEVERAGE CONTROL BOARD
TH
550 WEST 7
AVENUE, SUITE 540
ANCHORAGE, ALASKA 99501
PH. (907) 269-0350
Fax: (907) 272-9412
SPECIAL EVENTS PERMIT
PERMIT#________________
The _______________________________________________ ____________________________________________
(Name of Organization)
(Address)
a nonprofit fraternal, civic or patriotic organization hereby makes application under AS 04.11.240 for permission to serve
beer and wine at the event of _________________________________________________________________________
_____________________ located at____________________________________________________________________
Date of Event ___________________________________ Hours of Event _____________________________________
Contact Person _______________________________________ Phone Number ________________________________
FAX Number ________________________________
We certify that all profits derived from the sale of beer and wine at this event will be used solely by the above
organization and not by an individual. The organization was incorporated under AS 10.20 on ________________,
________ and has been active for a period of at least two (2) years. We agree to uphold all liquor laws and ordinances in
force. It is agreed that this permit will be surrendered to the board within forty-eight (48) hours of the expiration time as
required by Section 04.11.240. A fee of $50.00 per day accompanies this permit. A certified copy of the resolution of the
Board of Directors authorizing the application is attached to this permit.
_______________________________________________ ________________________________________________
President
Secretary
Subscribed and sworn to before me this ___________ day of ___________________, _________
_________________________________________
Notary Public in and for Alaska
My commission expires : ____________________
Approved________________________________________ Date ____________________________________________
(Local Law Enforcement Agency)
The above named organization is authorized to serve beer and wine at the event listed, on the date and at the location
described on the diagram below. This organization is hereby notified that any violation of the Alcoholic Beverage
Control Board laws or regulations will be charged against the organization. Failure to comply with all the provisions of
AS 04.11.240 and 15 AAC 104.675 may prevent the organization from acquiring future permits.
Approved:
Disapproved:
Date __________________________________
Reason Disapproved: ________________________________________________________________________________
Fees Received: __________________
_______________________________________
Alcoholic Beverage Control Board
PREMISES DIAGRAM
INSTRUCTIONS:
Draw a detailed plan of the premises where the event will be held in the space below; show all entrances and
exits, and all fixtures such as counters, bars, coolers, stages, etc. Include the dimensions of the premises.
.
Outline in red the areas where alcoholic beverages will be sold, served and consumed
Rev. 12/26/00
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