20___ State of Vermont Application for Caterer’s Permit License Year: May 1st through April 30th of following year. Fee: $200.00 Make check payable to and mail to: Vermont Department of Liquor Control Green Mountain Drive, Drawer 20 Montpelier, Vermont 05620-4501 Application is hereby made for a Caterer’s Permit to sell malt and vinous beverages and spirituous liquors on premises other than those occupied by a first, first and third, or second class license, under and in accordance with Title 7 of the Vermont Statutes Annotated, as amended, and certify that all statements, information and answers to questions herein contained are true, and in consideration of such permit being granted, do promise and agree to comply with all local and state laws; to comply with all regulations made and promulgated by the Liquor Control Board; to allow the Liquor Control Board and any of their assistants and investigators, to examine at any time the premises, supply of beverages, records and papers in reference thereto, and to keep such records as the Liquor Control Board may require; and upon hearing, the Liquor Control Board may in its discretion suspend or revoke such permit whenever it may determine that the law, or any regulations of the Liquor Control Board, have been violated, or that any statements, information or answers herein contained are false. The following questions shall be answered by all applicants: 1. Name and address of the first and third class license (except clubs) applying for permit: Licensee Name d/b/a Street Address Town or city 2. Are you making this application for the benefit of any other person? I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the state of Vermont as of the date of this application (VSA, Title 32, Section 3113). I/We hereby certify that the information in this application is true and complete. Signature of applicant/date All catering REQUESTS must first be submitted to the local control commissioners. No catering can be done until licensee has submitted a request for catering and OBTAINED APPROVAL FROM THE STATE LIQUOR CONTROL BOARD to cater to the function listed in the application. Requests for catering may be obtained from the Vermont Department of Liquor Control, Drawer 20, Montpelier, Vermont 05620-4501. Requests for catering should be received in the office of the Department of Liquor Control at least fifteen (15) days prior to the date of the function. American LegalNet, Inc. www.FormsWorkflow.com