DEPARTMENT OF LIQUOR CONTROL, COUNTY OF MAUI 2145 KAOHU STREET, ROOM 105, WAILUKU, MAUI, HAWAII APPLICATION FOR CATERER LICENSE Licensee: Trade Name: hereby makes the following application for a caterer license pursuant to Section 08-101-22(n), Rules of the Liquor Commission, County of Maui. 1. EFFECTIVE DATE & TIME(S): LOCATION: 2. Attached is a 8 ½” x 11” floor plan showing the boundaries of the proposed caterer license premises. 3. Attach a letter giving details of request, i.e. who is it for, minors in attendance, non-consumption areas, etc. 4. A lease, rental agreement or written authorization signed by the owner or representative of the property is required authorizing the applicant use and exclusive control of the property for the sale, service and consumption of liquor, therefore, subjecting said function and property to all liquor laws and inspections by investigators of the department of liquor control. 5. I hereby certify all necessary clearances from other government agencies have been obtained in reference to this application. Signature of CORPORATE OFFICER or AUTHORIZED AGENT Print Name/Title Date (FOR OFFICE USE ONLY) Date received: Application No.: Recommended by: Grant [ ] Refuse [ ] Approved for the Liquor Commission by the Director: License Fee: Page 1 of 1 DLC-015 [rev 12/02] American LegalNet, Inc. www.FormsWorkflow.com