5848 E Tudor Rd – Anchorage AK 99507 Phone - 907-269-0350 Fax – 907-272-9412 State of Alaska Alcoholic Beverage Control Board http://commerce.alaska.gov/dnn/abc/Home.as px Fee: $50 per day SPECIAL EVENTS PERMIT APPLICATION Alaska Nonprofit Corporation ______________________________ Is this event to take place on school or church grounds?  Yes If answer is “yes” contact ABC Board office before proceeding. Corporation:  No __________________________________________________ Alaska Corp ID#: _______________ Business Address: _________________________________________________ Date Incorporated: ______________ The corporation is a nonprofit fraternal, civic or patriotic organization, is incorporated and in “good standing” with the State of Alaska Division of Corporations, and is in compliance with AS 10.20. We hereby make application under AS 04.11.240 for permission to serve beer and wine at the following event: Event Name: ______________________________________________________________________ Event Location: ______________________________________________________________________ Event Date(s): ___________________________________ Hours of Event: ________________________________ $50 per day Contact Person: ___________________________________ Phone #: ______________ FAX # _________________ We certify that all profits derived from the sale of beer and wine at this event will be used solely by the above corporation and not by an individual. We agree to uphold all liquor laws and ordinances in force. 1. _______________________________________________ President _________________________________________ Notary Public in and for Alaska My commission expires: ____________________ ________________________________________________ Secretary Subscribed and sworn to before me this ______ day of ___________________, _________ 2. A certified copy of the resolution of the Board of Directors authorizing the event is attached to this application. 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 13 AAC 104.675 may prevent the organization from acquiring future permits. 3. Approved  Disapproved  By: _________________________________________ Date: ___________________ Local Police Dept. / Alaska State Trooper - Must be signed BEFORE ABC Board approval 4. Approved  Disapproved  By: _________________________________________ Date: ___________________ Alcoholic Beverage Control Board Reason Disapproved: _____________________________________________________________________________________ CREDIT CARD PAYMENT ACCEPTED BY PHONE: 907-269-0350 Rev. 07/31/12 American LegalNet, Inc. www.FormsWorkFlow.com State of Alaska Alcoholic Beverage Control Board http://commerce.alaska.gov/dnn/abc/Home.as px 5848 E Tudor Rd – Anchorage AK 99507 Phone - 907-269-0350 Fax – 907-272-9412 Fee: $50 per day Instructions: Draw a detailed diagram of the premises 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. Outline in red all areas where alcoholic beverages will be sold, served and consumed. List all servers: NAME 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 Rev. 07/31/12 American LegalNet, Inc. www.FormsWorkFlow.com