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I have read the Application and the Permit and Agreement for this Special Event and I affirm the truth of <br />the information provided by me to the best of my knowledge. I understand and agree to the above rules <br />and regulations, and any applicable state and federal laws. I also understand that this application may be <br />denied based on any false or incomplete information. <br />Date: 06/9/2021 <br />Ellen McCoy <br />2021.05.19---- <br />0 <br />Applicant Signature: t�v 2021.05.-- 13--- -04'00' <br />Printed Name: JO Ellen McCoy <br />President <br />Memb r <br />SPECIAL EVENTS COMMITTEE APPROVAL <br />Member <br />Member <br />Membe <br />//1) <br />Date <br />