State of California Department of Alcoholic Beverage Control 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 9. EVENT DATE(S) 10. TOTAL NUMBER OF DAY(S) Yes 11. EVENT HOURS No 12. EVENT OPEN TO THE PUBLIC 13. ESTIMATED ATTENDANCE From To Yes No 14. NUMBER OF DAYS AN 'ADJACENT PROPERTY' EVENT HELD AT THIS LOCATION THIS CALENDAR YEAR 15. LOCAL LAW ENFORCEMENT AGENCY APPROVAL SIGNATURE 16. TITLE 17. DATE SIGNED I declare under penalty of perjury that to the best of my knowledge these statements are true and correct. LICENSEE SIGNATURE DATE SIGNED AUTHORIZATION (For ABC Use Only) CONDITIONS/ACKNOWLEDGMENTS REQUIRED DIAGRAM REQUIRED LAW ENFORCEMENT APPROVAL REQUIRED Yes, attached No Yes, attached ABC EMPLOYEE SIGNATURE No Yes DATE SIGNED No DISTRICT APPROVAL BY (Name) ABC-215 (rev. 01/14) American LegalNet, Inc. www.FormsWorkFlow.com