CATERING AUTHORITY REQUEST / TYPE 222 Send, deliver, mail, or fax to: District #1 1. Applicant must complete all requested information. 2. Please type or print clearly. 3. Submit application to the local excise district office. District #2 District #5 istrict #3 INSTRUCTIONS: District #4 District #6 STEP 1. PERMITTEE INFORMATION as it appears on your alcoholic beverage permit number and street, city, state, ZIP code month, day, year STEP 2. EVENT INFORMATION (A SEPARATE REQUEST MUST BE SUBMITTED FOR EACH EVENT ) if applicable number and street, city, state, ZIP code STEP 3. FLOOR PLAN (SEE STEP 4, #2 ) I swear or affirm under penalties of perjury that all the information contained on the entire application is true and accurate. month, day, year Signature of permittee / agent acknowledges that you have read the rules and guidelines (Step 4) and that you agree to abide by them.) FOR DISTRICT USE ONLY month, day, year must be signed by district lieutenant or sergeant American LegalNet, Inc. www.FormsWorkFlow.com STEP 4. RULES AND GUIDELINES The following are guidelines for the approval of an event catered by a supplemental caterers permit: All applications should be received a full fifteen (15) days prior to the event. see #2, 3 above see #9 above Note: Please post your approved request in a conspicuous place where the alcoholic beverages are being dispensed at the catered location. If for any reason this request is denied, you may be notified either in person or by phone, and you will be notified by registered mail. (IC 7.1-3-9.5-2) American LegalNet, Inc. www.FormsWorkFlow.com