Special Events License Form/affidavit Of Character/liquor License Application Criminal Record Check

RDS

Attn: City of Sulphur Special Events License

9618 Jefferson Highway, Suite D #334

Baton Rouge, LA 70809

Phone: 800-556-7274

Fax: 844-528-6529

YEAR _________CITY OF SULPHUR (1680) SPECIAL EVENTS LICENSE

Please complete this application and return along with your payment

Current Date:

_________________________________

RDS Account Number: _____________________

Business Name:__________________________________________________________________________________________

Business Address: ________________________________________________________________________________________

Application is for high content________ low content__________

1. Name of Event:

______________________________________________________________________________________

2. Event Location:

______________________________________________________________________________________

3. Legal Name of Organization:______________________________________________________________________________

4. Mailing Address: _______________________________________________________________________________________

5. Home/corp Address: ____________________________________________________________________________________

6. Business Telephone: ___________________Home/corp Telephone: _______________________

7. Type of organization: must attach 501(c) 3 tax exemption

Civic_________Religious__________Non-Profit__________ For-Profit__________

8. Give names of contact persons or principal officers: ____________________________________________________________

9. Event date (not to exceed 3 consecutive days): _______________________________________________________________

10. Describe in detail the type of event activity or service you will perform:____________________________________________

Calculate License Fee Instructions:

Schedule: 318.00 Special Events

$ ____100.00 ______

Step 1. Special Event License Fee:

Step 2. Total Remittance:

$_________________

Make check payable to “Tax Trust Account.” Remit payment to

RDS. Attn: City of Sulphur Special Event License,

9618 Jefferson Highway, Suite D #334, Baton Rouge, LA 70809

I affirm that the information given on this application is true and correct.

Signature of Applicant: _____________________________________________ Title: __________________________________

Tax ID#/SSN: ____________________________________________________ Date: __________________________________

Print Name of Applicant: ________________________________________ Telephone: _________________________________

Returned Check Disclaimer: Effective July 1, 2010, each returned item received by RDS due to insufficient funds will be electronically represented to the presenters’ bank no more than

two times in an effort to obtain payment. RDS is not responsible for any additional bank fees that will accrue due to the resubmission of the returned item. Please see the full returned

check policy at

Special Events License Form/affidavit Of Character/liquor License Application Criminal Record Check - City Of Sulphur

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