State of Alaska Alcoholic Beverage Control Board 5848 E Tudor Rd – Anchorage AK 99507 Phone - 907-269-0350 Fax – 907-272-9412 http://commerce.alaska.gov/dnn/abc/Home.aspx    $50 - Beverage Dispensary 13 AAC 104.685 $50 - Restaurant/Eating Place 13 AAC 104.680 $100 - Club See Signature ** 13 AAC 104.690 Licensee must mark correct type CATERING PERMIT APPLICATION _____________________ NOTICE TO APPLICANT: After approval by the appropriate law enforcement authority, send the completed form along with the required fees to the Alcoholic Beverage Control Board. When approved, a permit will be issued for posting at the event. Is this event to take place on school or church grounds?  Yes If answer is “yes” contact ABC Board Office before proceeding.  No Licensee Name: ________________________________________________ License #: ______________________ Doing Business As: ________________________________________________ Contact Person: _____________________ Mailing Address: ________________________________________________ City/ST/Zip: ________________________ Phone: __________________________ Fax: __________________________ The licensee named above hereby makes application under Alcoholic Beverage Control Board regulation 13 AAC 104.680, 104.685, or 104.690 for permission to cater the event and temporary premises described below. Event Name: __________________________________________ Location: ___________________________________________ Date(s): _________________________ Time: ________________________ I/We certify this written notice is submitted as required under 13 AAC. Any person observed to be giving or selling alcoholic beverages to a person under the age of 21 or to a drunken person may be cited under AS 04 .16.030, AS 04.16.040, AS 04.16.050, AS 04.16.051, AS 04.16.052 or AS 04.16.060. 1. SIGNATURE OF LICENSEE(S): ______________________________________________________________________ ** Club License: Signature of Presiding Officer AND Secretary are required. 2. Approved  Disapproved  By: _________________________________________ Date: ___________________ Local Police Dept. / Alaska State Trooper - Must be signed BEFORE ABC Board approval This permit is only for the event on the date and at the location requested. The licensee(s) is hereby notified that any violation of any Alcoholic Beverage Control Board law or regulation will be charged against the licensee(s). This permit will be issued unless a protest is noted by the appropriate police authority, or if the Board finds that it would not be in the best interest of the public. 3. Approved  Disapproved  By: _________________________________________ Date: ___________________ Alcoholic Beverage Control Board Fairbanks & Juneau Investigators Sign Forms in their Jurisdictions Reason Disapproved: _____________________________________________________________________________________ Instructions: Draw a detailed diagram of the premises where the event will be held in the space below (or on a separate sheet of paper); show all entrances and exits, and all fixtures such as counters, bars, coolers, stages, etc. Include the dimensions of the Premises. Outline in red all areas where alcoholic beverages will be sold, served and consumed. Revised 03/01/12 American LegalNet, Inc. www.FormsWorkFlow.com State of Alaska Alcoholic Beverage Control Board 5848 E Tudor Rd – Anchorage AK 99507 Phone - 907-269-0350 Fax – 907-272-9412 http://commerce.alaska.gov/dnn/abc/Home.aspx List all servers: NAME    $50 - Beverage Dispensary 13 AAC 104.685 $50 - Restaurant/Eating Place 13 AAC 104.680 $100 - Club See Signature ** 13 AAC 104.690 Licensee must mark correct type DOB AK Driver’s Lic # Alcohol Server Card * ______________________________________ ________________ __________________ Yes  No  ______________________________________ ________________ __________________ Yes  No  ______________________________________ ________________ __________________ Yes  No  ______________________________________ ________________ __________________ Yes  No  ______________________________________ ________________ __________________ Yes  No  ______________________________________ More servers may be listed below. ________________ __________________ Yes  No  * Various municipalities require the alcohol servers be certified before serving at an event. Revised 03/01/12 American LegalNet, Inc. www.FormsWorkFlow.com