Ballroom Supplemental License Application
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Ballroom Supplemental License Application Form. This is a New Hampshire form and can be use in Liquor Commission Statewide.
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Tags: Ballroom Supplemental License Application, New Hampshire Statewide, Liquor Commission
State of New Hampshire
LIQUOR COMMISSION
BALLROOM SUPPLEMENTAL LICENSE APPLICATION
Application for supplemental license for Ballroom as pursuant to RSA 178:20, V (c) (3)
**This application must be submitted at least five business days prior to the function and be accompanied by a $45.00 fee.**
APPLICANT DATA
LICENSE NUMBER:
TRADE NAME:
PHONE#:
APPLICANT ADDRESS:
LICENSE EXPIRATION DATE:
FUNCTION DATE:
START TIME
END TIME
NAME OF SOCIAL CLUB/ORGANIZATION/FAMILY & SOCIAL FUNCTION: (IE: Wedding, Birthday etc.)
If only part of the premise is to be used for the function: the applicant shall maintain the minimum 500 seating requirements for a
ballroom, if the ballroom facility is open to the public at the same time.
ENTERTAINMENT
If Exotic Dancers or other unusual entertainment is to be part of the function, attach written local city/town approval and describe the entertainment
in detail.
APPLICANT’S CERTIFICATION:
I certify under the penalties of RSA 641:3 that all information is true and correct and all required documentation is attached.
__________________________________________________________________ __________________________________
Owner/Partner/Officer/Member/ Manager Signature
Date
Dml 10/19/00
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