Social Affair Permit Bellmawr

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APPLICATION FOR
STATE OF NEW JERSEY
DEPARTMENT OF LAW AND PUBLIC SAFETY
SOCIAL AFFAIR PERMIT [SA]
DIVISION OF ALCOHOLIC BEVERAGE CONTROL
P.O. BOX 087, 140 EAST FRONT STREET
TRENTON, NJ 08625-0087
APPLICATION MUST BE SUBMITTED AT LEAST TWO WEEKS PRIOR TO THE EVENT
Applications must be accompanied by a fee of $100.00 PER DAY for Civic, Religious, or Educational Organizations; $150.00 PER DAY
for all other NON-PROFIT organizations, in the form of a check or money order payable to the DIVISION OF ALCOHOLIC BEVERAGE
CONTROL.
NOTICE: ORGANIZATIONS MAKING APPLICATION FOR THE FIRST TIME, MUST SUBMIT PROOF OF NON-PROFIT STATUS IN
NEW JERSEY. COMBINATIONS OF CERT IFICATE OF INCORPORATION, CHARTER OR BY-LAWS, FEDERAL TAX EXEMPT
CERTIFICATE, FINANCIAL RECORDS A ND MEMBERSHIP LIST (NAMES AND A DDRESSES INCLUDED) ARE ACCEPTABLE
FORMS OF PROOF. THE DIVISION OF ALCOHOLIC BEVERAGE CONTROL RESERVES THE RIGHT TO REQUEST ADDITIONAL
INFORMATION IF DOCUMENTATION SUBMITTED IS NOT SUFFICIENT.
Pursuant to N.J.S.A. 33: 1-74 and N.J.A.C. 13:2-5.1, the undersigned makes application for a Special Permit to sell, dispense and serve
:
alcoholic beverages for consumption at an affair as stated herein
Organization Information
1.
Name of Organization: _____________________________________________________________________________________
Address: ________________________________________________________________________________________________
2.
Does organization hold a liquor license? Yes ☐
No ☐ If yes, ____________-______31_____-_____________-_____________
(CLUB LICENSE’S ONLY)
3.
Has organization held a special permit for Social Affair during the past 3 years? Yes ☐
No ☐ If no, supply proof of non-profit
status from NOTICE paragraph above. Previous Permit No: _______________________
4.
Contact ____________________________________________ Phone Number: _______________________________________
5.
E-mail address ___________________________________________________________________________________________
6.
Mailing address ___________________________________________________________________________________________
Premises Information
7.
Location of premises where affair will be held: (
)
Describe Specifically
Name of premises _________________________________________________________________________________________
Address of premises _______________________________________________________________________________________
8.
Is the above named premises licensed? Yes ☐
No ☐
If yes, __________-__________-__________-__________
9.
Are the premises where the affair is to be held owned by a municipality, county or state? Yes ☐
No ☐
If yes, state the name of owner _______________________________________________________________________________
For what purposes are premises used? ________________________________________________________________________
Does the premise conduct mercantile business? Yes ☐
No ☐ If yes, what is sold? ____________________________________
Event Information
10. What date(s) will affair be held and between what hours alcoholic beverages will be dispensed (Dates must be consecutive to be
on one application):
MM/DD/YY
START
END
am pm
am pm
/
/
am pm
am pm
/
/
am pm
am pm
/
/
Rain Date (only one rain date): __________________________________________________________
11. What is the specific fundraising event being held? ________________________________________________________________
12. How is a charge assessed? Ticket ☐
Contribution ☐
Other : ____________________________________________________
(SPECIFY OTHER)
13. Who is the recipient of the proceeds? __________________________________________________________________________

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