New Approved/Disapproved Renewal VERMONT DEPARTMENT OF LIQUOR CONTROL If this is a renewal Enforcement & Licensing Division with changes please OUTSIDE CONSUMPTION PERMIT indicate below, if there are no changes, it is not necessary to complete each year. Office Use Only Name of Licensed Premise (Corporation/Partnership/Individual, d/b/a) _______________________________________________________________________________________ d/b/a___________________________________________________________________________________ Address_________________________________________Town/City_______________________________ License Number ________________________________________ Outside consumption would be in the area described below: (describe fully, including size, physical barriers, etc.) _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Outside Consumption time period (hours) from __________________ to _______________ Permanent Use from __________________ to ________________ Month/Day __________________ Month/Day ___________________ Occasional Use Day(s) Requested _______________________________________________ Signature of Licensee ____________________________________________ APPROVED BY LOCAL CONTROL COMMISSIONERS Town/City Clerk Signature ____________________________________________________ Date APPROVED BY DEPARTMENT OF LIQUOR CONTROL Investigator/Enforcement Office________________________________________________ Signature Date Please remember that this outside consumption permit is an extension of your license to serve alcohol beverages, and that the same rules apply in this area as do in the regularly licensed premise area. cc: Licensee Town Investigator File Enf 02/03 American LegalNet, Inc. www.FormsWorkflow.com