STATE OF ALASKA ALCOHOLIC BEVERAGE CONTROL BOARD 5848 E Tudor Rd ANCHORAGE, ALASKA 99507 PH. (907) 269-0350 Fax: (907) 272-9412 www.dps.state.ak.us/abc 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: __________________ INSTRUCTIONS: _______________________________________ Alcoholic Beverage Control Board PREMISES DIAGRAM 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.