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Paid $25.00 <br /> chk#425 <br /> °J too NG 0F1 1S LS U tS <br /> TOWN OF LEXINGTON D <br /> 5 .1 _ <br /> a Aw A SELECTMEN'S OFFICE <br /> a� FEB 2 4 2017 <br /> APRIL 19*N <br /> L�xzKvxo APPLICATION FOR <br /> ONE-DAY LIQUOR LICENSE SELECTMEN <br /> The Board of Selectmen issues one-day liquor licenses to for-profit and non-profit organizations <br /> that serve liquor and charge either a cover charge or for each drink. Please fill in this form <br /> completely and return to the Selectmen's Office along with a check for $25.00 made payable to the <br /> Town of Lexington. <br /> BUSINESS/FUNDRAISING ORGG NIzA�TIO : <br /> CONTACT NAME AND NUMBER: <br /> ADDRESS FOR MAILING: <br /> EMAIL ADDRESS: �A , , <br /> TITLE/PURPOSE OF EVENT: t=c, A4aw�QM <br /> LOCATION AND ADDRESS: ZED& 61'��/ <br /> a <br /> ZLeto <br /> DATE OF FUNCTION: p�j/,J/.� , <br /> TIMES OF FUNCTION: L��f�t��/,�• pp Q v <br /> TYPE OF LIQUOR TO BE SERVED: 4i&j &Ad 4gdr, <br /> DATE AND TIME WHEN LIQUOR DELIVERED: dot/W/� Qom- •� <br /> DATE AND TIME WHEN LIQUOR REMOVED: G /�/�o/�' c /•�,•Op ct,[N <br /> ADDITIONAL INFORMATION: <br /> Authorized Signatu e Federal Identification No. or <br /> Social Security Number <br />