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BEER I WINE AUTHORITY I TYPE 118 <br />Stale Form 35494 (R8111-16) <br />,. Approved by Slate Board of Aanunts, 2015 <br />ems' <br />INSTRUCTIONS: i. Applicant must complete all requested information. <br />2. Please type or print clearly. <br />3. Submit application and payment to the local excise <br />district office. <br />Send, deliver, or mail to: <br />DISTRICT 1 <br />52422 County Road 17 <br />Bristol, IN 46507 <br />Telephone: (574) 264-9480 <br />DISTRICT 2 <br />1353 South Governors Drive <br />Columbia City, IN 4672S <br />Telephone: (260) 244-4285 <br />DISTRICT 3 <br />279 West 300 North <br />Crawfordsville, IN 47933 <br />Telephone: (755) 362-8815 <br />DISTRICT 4 <br />651 S. Commerce Dr, <br />Seymour, IN 47274 <br />Telephone: (812) 523-8314 <br />DISTRICT 5 <br />3650 South US Hwy 41 <br />Vincennes, IN 47591 <br />Telephone:1812) 082-1292 <br />DISTRICT 6 <br />6400 East 301h Street <br />tndianapolis, IN 46219 <br />Telephone: (317) 541 ■4100 <br />STEP 1. GENERAL INFORMATION <br />Name orapplicant applying for permit (organization, club, corporation, Individual) <br />TM Permit number pssuedbyAX) <br />Our Lady of Hungary Catholic Church <br />Address of applicant (numberand street city, state, and ZIPWo) <br />E-mail address <br />731 West Calvert Street South Send, IN <br />46613 <br />rect"ouriadyothungary@gmall,com <br />Name of person making appllcaiion <br />Father Kevin Bauman <br />Fax number <br />i 574 ) 289-6704 <br />Emergency contact telephone number <br />( 574 ) 339.3124 <br />Printed name of contact person of event <br />Karen Carizzosa <br />Emergency contact WepliQno number <br />( 574 ) 202-4040 <br />.STEP 2. EVENT WFORMATION <br />Beginning day <br />Saturday <br />8eginning date (month, day, year) Ending day <br />Juiy 15, 2017 Saturday <br />Ending date (month, day, year) <br />July 15, 2017 <br />Time of event <br />Start time 1:30 <br />' <br />El AM ❑v PM J End time <br />10:0D ❑ AM [0 PM <br />Type or description of event <br />Parish Festival <br />Exact address of avant (nurnberandstreet, clty, stale, and ZIPcode) <br />731 West Calvert Street, South Bend, IN 46613 <br />STEP 3.. FLOOR PLAN See Stop +4, Number 2 <br />1. <br />3 L <br />I <br />I <br />I C+q <br />1 e i, <br />l <br />m , <br />1 <br />_i.��b r <br />_ t <br />I <br />( <br />G <br />( I <br />a <br />1 1 <br />Fj- <br />10 <br />...I <br />... <br />+1 <br />h <br />... <br />TT <br />'1 <br />�ID.a�O.-Ti <br />t44v�M j. • ,n j-#) <br />4'OM0 <br />Page 1 of 2 <br />