Application_Permit to consume alcohol on Shire property

Application - Permit to consume alcohol on shire property
Important information

1) Applicants must be 18 years of age and over.

2) This application is a request for permission to consume liquor at a Shire Facility ONLY. Under no circumstances does it give the hirer authorisation to sell liquor directly or indirectly, or change an entry fee into a function.

3) Approval to sell liquor must be obtained from the Department of Racing, Gaming and Liquor. Apply here.

4) If approved, the original permit will be returned to the application. This permit must be ready for inspection at the facility on the date(s) of the scheduled booking.

5) This application must be submitted at least 5 working days prior to the event.

1.0 - Organisation details

(If applicable)
Name of organisation*
Address for correspondence*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

2.0 - Nominated individual responsible for the permit to consume and/or sell alcohol
Name*

First NameLast Name
Contact number*
Email*
example@example.com

3.0 - Event details
Location of Function*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Function *

MonthDayYear
Start Time*

Hour Minutes

AM/PM Option
Finish Time*

Hour Minutes

AM/PM Option
Type of Function*
Expected number of attendees*

4.0 - Alcohol
Method of Distribution (please select all that apply)*

SupplySaleBring Your Own
Liquor Licence Number*
Safety Requirements*

I acknowledge that I am required to liaise with local police about this event.

5.0 - Conditions
I/We agree and undertake that in the event of this application being approved by Shire, the following conditions will be strictly adhered to:

1) Only invited guests or bona fide members of the applicant’s group, organisation or club will consume liquor on the premises and no others.

2) Alcohol will not be consumed, supplied or made available for any person under the age of 18 years.

3) If it is the intention of the applicant to sell alcohol to any person, or exchange for value, either directly or indirectly, a permit must first be obtained from the Department of Racing, Gaming and Liquor and a copy of this permit is attached to this application.

4) Alcohol consumption is restricted to the premises hired only and is not to be consumed outside these premises. Consumption on public open space or a reserve area is considered illegal.

5) The hirer must comply with the provision of the Liquor Licensing Act 1988

6) The hirer is responsible for liaising with local police about the event.
Signature*

First NameLast Name
Date *

MonthDayYear
Should be Empty: