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2. 
4. One-Day Liquor License Application
6. FEE - $50.00
7. CERTIFICATE OF LIQUOR LIABILITY MUST BE SUBMITTED WITH APPLICATION. THE VILLAGE OF CHANNAHON MUST BE THE CERTIFICATE HOLDER ON INSURANCE.
9. Date of Event
   Date of Event
10. Beginning Time of Event
    Beginning Time of Event
11. Ending TIme of Event
    Ending TIme of Event
13. Organization Name
15. Applicant Name with Middle Initial
16. Date of Birth
18. Address
20. City
21. State
22. Zip Code
24. Phone Number
26. Email Address
28. Address of Event
30. City
31. State
32. Zip Code
34. Approximate number of persons expected
35. Type of Event

    1. Fund Raiser
    2. Picnic
    3. Wedding
    4. Other - Explain
36. Explanation
38. Entertainment, if yes what type
40. The applicant agrees to hold the Village of Channahon and its officials and employees harmless of any claim or injury arising out of the use any public street, sidewalk or facility in conjunction with the terms and conditions of this license.
42. The applicant, its officers, directors, agents or managers, agree to follow all ordinances of the Village of Channahon and the laws of the State of Illinois. In accordance with the Village Ordinance #1802.
44. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
46. Electronic Signature
47. Date
    Date
52. CC: Chief of Police
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit Submit and Print

* indicates a required field