Fillable Social Affair Permit Bellmawr (Page 3 of 3) in pdf

NO PERMIT WILL BE GRANTED UNLESS WRITTEN APPROVALS FOR BELOW ARE OBTAINED

ORIGINAL SIGNATURES ONLY

If a Special Permit is granted, applicant agrees that alcoholic beverages will not be sold or served to anyone under the legal age, nor

will such persons be permitted to co nsume alcoholic beverages at aforesaid affair a nd certifies that all c onditions set forth i n said

Permit, all rules and regulations pertaining thereto and all ordinances and/or resolutions of the municipality where aforesaid affair is to

be held will be complied with; and that permission is hereby given the Director of the Division of Alcoholic Beverage Control, Division of

Taxation, and their d uly authorized investigators and agents, and to a ny local peace officer to investigate the sale of alcoholic

beverages at the social affair for which this application is made.

Gambling, mock gambling and gambling paraphernalia are not permitted on the premises licensed by the Special Permit unless

otherwise approved by the Legalized Games of C hance Commission (973) 273-8000. I HEREBY CERTIFY THAT THIS

ORGANIZATION HAS NOT EXCEEDED ITS LIMIT OF 12 SPECIAL PERMITS DURING THIS CALENDAR YEAR.

_________________________________________________

(Signature of Authorized Officer and Title)

(Name of Organization)

Date of Signature___________________________________

I hereby certify that there is no objection to the granting of a Special Permit to above applicant to sell alcoholic beverages at the affair to

be held on aforesaid date and premises, subject to, however, the following Special Conditions (if any):

_________________________________________________

(Signature of Chief of Police)

(Municipality where affair is to be held)

Date of Signature___________________________________

I hereby certify that the License Issuing Authority of this municipality has no objection to the granting of a Special Permit herein applied

for and consents thereto. I further certify that the issuance of said Permit is not contrary to any local ordinance, resolution, regulation or

policy which would prohibit same.

_________________________________________________

(Signature of Clerk)

_________________________________________________

Date of Signature: _______________________________

(Municipality where affair is to be held)

The following consent is to be signed by the person so authorized of the premises where the affair is to be held.

I hereby certify that I am the person in charge of the premises upon which the herein affair will be held, that I am fully authorized to and

do hereby certify that there are no objections to the sale and service of alcoholic beverages upon such premises at suc h affair. I

HEREBY CERTIFY THAT THIS PREMISE HAS NOT EXCEEDED ITS LIMIT OF 25 SPECIAL PERMITS DURING THIS CALENDAR

YEAR.

_________________________________________________

Date of Signature___________________________________

(Signature and Title)

NOTE: THE DIVISION MUST BE NOTIFIED FOR CANCELLATION OR RESCHEDULING PRIOR TO THE DATE OF

THE EVENT.

Issuance of the Special Permit will allow the organization to purchase alcoholic beverages for resale at the affair specified in

the application from any licensed wholesaler or retailer. All advertising, tickets, etc., for the affair which contain reference to

alcoholic beverages must include this Permit Number.

Rev. 01/13

Social Affair Permit Bellmawr Page 3