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Paid$25.00 <br /> uS MORIvt� lJ 9 lJ <br /> o c <br /> I 9W #�; TOWN OF LEXINGTON <br /> SELECTMEN'S OFFICE FEB 1 2017 <br /> APRIL f9- <br /> LFxINC"150 APPLICATION FOR SELECTMEN <br /> ONE-DAY LIQUOR LICENSE <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 ORGANIZATION: (sxt4A-r*j EdO&"104 <br /> CONTACT NAME AND NUMBER: LAA-6w4ki G(7-13o-66 s6 <br /> ADDRESS FOR MAILING: 17b &AAP-fir. L"VjArw Mk exgZa <br /> EMAIL ADDRESS: tanQccl�.er� <br /> TITLE/PURPOSE OF EVENT: g;jAag, gSg rox Js4+rc4r(& �t t-C. pgA�tV <br /> LOCATION AND ADDRESS: 144jW fuc Laic <br /> DATE OF FUNCTION: Au— to zoq <br /> TIMES OF FUNCTION: �hkF <br /> TYPE OF LIQUOR TO BE SERVED: �,,�,� «� <br /> DATE AND TIME WHEN LIQUOR DELIVERED: Ton,,,. to, 2atT <br /> DATE AND TIME WHEN LIQUOR REMOVED: M M47 <br /> ADDITIONAL INFORMATION: 5cM" cum A MU,& 144-m„ I <br /> c c� <br /> Authorized Signature Federal Identification No. or <br /> Social Security Number <br />