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Name of applicant(individual,corporat(on;partnership,I LC,LLP) <br /> I certify that this application was completed by myself or by the preparer Identified herein. 1 certify that all information provided herein and on any attachments are <br /> true and correct, I UNDERSTAND THAT IT IS A FELONY TO MISREPRESENT OR FALSIFY ANY PORTION OF THIS APPLICATION OR ATTACHED <br /> DOCUMENTS. <br /> i hereby consent for the duration of the permit term to Inspection and search by an enforcement officer,without a warrant or other process,of my licensed premise <br /> and vehicles to determine compliance with the provisions of I.C.7.1. <br /> Printed name and title of applicant Signature Date <br /> NOTE.The applicant MUSTslgn this application unless Me proper Power of Attomey forms are attached to this application. <br /> I certify that I have examined this application and the accompanying documents,and to the best of my knowledge and belief,they are true,correct,and complete. <br /> Signature of preparer Telephone number(indudFng area ride} Date <br /> 1. <br /> Please rent business,ceriihed checks,or money order-appficalion wail not be processed without payment MAIL TO: <br /> One-way(beer only)= $500 <br /> Two-way(beer&wine only)= $750 INDIANA ALCOHOL&T013ACCO COMMISSION <br /> Three-way(beer,wine,&liquor) $1,000 302 W.Washington Street,Room El 14 <br /> Except Fraternal Clubs= $250 Indianapolis,IN 46204 <br /> Catering= $156 (317)232-2430 <br /> Transfer of Permit" $250 Each transfer type http:www.state.in.us/atc <br />