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`� a <br />xn REF=R I WINE: 11llfHCiRITV I TYPE 118 <br />�e <br />U 1 �.r r r m uI Carr I l• •rrl .4`p Lc ai p I t ...I ro <br />I <br />iir .. •^I ail,] <br />.. .. <br />IN' S lHVCTIrJhS <br />I AppIK'dnl must CnmUrcl_ J. I .r. ! nlorm,)14rn <br />[1I]'Rif 'I <br />UIjIkICi> <br />2 Please 7YPe or punt Dearly <br />r 153 ?.r. Ir-'.rn.ernor;, i3r.: <br />�. 3h50 Scull, US ,rt,, 4 <br />J Submit dppllcabor and payment to the lmal e,ise J smcl office <br />I-,numGa -,IV IN 4h7i5 <br />ymcennez IIN 4 59` <br />4 4lleventsare35000Pe,day(90514C 1 11 1 I) Rusmesschecxsarmmon>y <br />leleor,,e iie(l)244_A!8 <br />Teleprgne II'L 66.1 + 112 <br />alders made payable In the Indiana Alcohol and tobacco (omms Sro,r arc acreprpo <br />OIS TRICt 3 <br />DISTRICT 6 <br />5 Serving past midnight nn later than 9 AM. is fine !i' Oay <br />b No rainChQcheckssooa <br />n any of IDe listed events <br />.I t N.USI 100 Nunn <br />5400 F a>I 'lh `nr-,.I <br />Gdn'IprVsmHe IN4'9)1 <br />IN;621d <br />T"ernonc ,I,i) 1b7 tY,"- <br />Iglenrvor>F Ili', -:'. 4tOC <br />VI$rthapIlAVWWmdoytatUseoYl30_bpg tot additional intrimahon about the dls Nrcis <br />r------ <br />---------- -- -- - - --' <br />,. f-'.i t. GENERAL INFORMgTION. �';'Yf "_'!;j,^'�r,4„�'�t <br />lK 9T; I�• -�^,-r <br />_STEP <br />Name of appBTam apanrg Im amm (witimaalmc,club, cages f m. nldnou.Q <br />TM Permit number IrssulW by AIQ <br />Our Lady of Hungary Parish <br />_ -.- <br />Atldressa apa t'dm (number, dsr .•t. rrlr ",,re a tlZ)P Gale) <br />F ae aCe•er, <br />735 West Calved <br />ddomonkos@sbcsc k 12 In us <br />Namea person maxmg app¢mo ------ <br />_ <br />ca bet <br />m) <br />Eme�gencY cpnlan teiepxdrt number <br />Denise M Domonkos <br />5 741 300 - y l y 7 <br />Printed name d remaU perwn d evem _ <br />� -- � <br />___ <br />i4 uwrgenc, .umaCl relepnone number j <br />Denise M Domonkos <br />i 57-t t qO f4 f <br />Begrm�ng da, Bnrynrt <br />Salulday <br />Time of ereM <br />—�— <br />Stan bma 400 <br />Type a eesuralon d evLva <br />•Our Lady of Hungary Parish Festival <br />EYad address d evem (number and sheer ply. s11e. <br />735 W. Calvert South Bend, IN 46613 <br />STEP 2. EV <br />q Gale imootn day, year) <br />July 15, 2021, <br />❑ AM IGJ PM <br />VF,OI?MRTIPl+Jt<__•'6 — <br />Eris, day j �Mmq Ease (mouth day real <br />Saturday July 15, 2023 <br />Fnl mrv' 900 JAM Q PM <br />I <br />jloRTy I <br />I t�>71'rAL i 'i <br />� I <br />i <br />1 <br />crtuxui (.07 <br />—. <br />&lf!!y <br />P.P EE <br />i <br />jY 1 <br />I <br />