State of California Department of Alcoholic Beverage Control CATERING OR EVENT AUTHORIZATION APPLICATION LICENSE NUMBER Please read instructions before completing form. RECEIPT NUMBER TOTAL FEE $ SECTION 1 1. LICENSEE NAME(S) (If an individual, first name, middle name, last name.) 2. CONTACT PERSON 3. CONTACT PHONE NUMBER 4. LICENSED PREMISES ADDRESS 5. MAILING ADDRESS (IF DIFFERENT) 6. EVENT LOCATION (Street number and name, city, zip code) 7. DESCRIPTION OF LOCATION (Parking lot, office building, residence, county/city park, etc.) 8. EVENT LOCATION IS WITHIN THE CITY LIMITS 10. TOTAL NUMBER OF DAY(S) 12. EVENT OPEN TO THE PUBLIC Yes 9. EVENT DATE(S) 13. ESTIMATED ATTENDANCE No 11. EVENT HOURS From To Yes SECTION 2 No CATERING EVENT 14. EVENT TYPE Convention Trade Exhibit Social Gathering Anniversary Sporting Event Picnic Wedding 15. NUMBER OF EVENTS CATERED THIS YEAR AT THIS LOCATION (Not applicable to club licensees) Birthday Other Event Authorized Pursuant to Business and Professions Code Section 25600.5 16. ORGANIZATION SPONSORING EVENT 17. PERSON IN CHARGE OF EVENT 18. MAILING ADDRESS 19. PHONE NUMBER OF ABOVE PERSON SECTION 3 EVENT ON ADJACENT PROPERTY 20. NUMBER OF DAYS AN 'ADJACENT PROPERTY' EVENT HELD AT THIS LOCATION THIS CALENDAR YEAR 21. LOCAL LAW ENFORCEMENT AGENCY APPROVAL SIGNATURE 23. TITLE 24. DATE SIGNED SECTION 4 I declare under penalty of perjury that to the best of my knowledge these statements are true and correct. LICENSEE SIGNATURE DATE SIGNED SECTION 5 AUTHORIZATION (For ABC Use Only) PROPERTY OWNER APPROVAL REQUIRED Yes, attached No DISTRICT APPROVAL BY (Name) CONDITIONS/ACKNOWLEDGMENTS REQUIRED Yes, attached No DIAGRAM REQUIRED Yes, attached ABC EMPLOYEE SIGNATURE LAW ENFORCEMENT APPROVAL REQUIRED No Yes No DATE SIGNED ABC-218 (rev. 07/11) American LegalNet, Inc. www.FormsWorkFlow.com