Catering Authority Form

CATERING AUTHORITY / TYPE 222 State From 50184 6-01 State Excise Police INSTRUCTIONS Send deliver mail or fax to District 1 52422 County Road 17 Bristol IN 46507 Fax 574-264-9348 1. The wholesaler servicing a supplemental caterer may deliver the alcoholic beverages directly to the location of the catered event if the supplemental caterer has his letter of authority posted at that location. 10. A supplemental caterers permit is to be used for a specific off premises function or event and not for a permittee to use any adjoining or remote facilities to enlarge or enhance his own business enterprises. 11. Have you Completed Step 3 a drawing of your proposed floor plans Read and signed the catering guidelines Is thie event or function open to the public enforcement agencies of your intent to cater this event have you done so 1. Applicant must complete all requested information* 2. Please type or print clearly. 3. Submit application to the local excise district office. District 4 651 S* Frontage Rd Seymour IN 47274 Fax 812-522-5681 District 2 1353 South Governors Drive Columbia City IN 46783 Fax 260-244-3830 3650 S* US 41 Vincennes IN 47591 Fax 812-882-1386 District 3 279 W* 300 N* Crawfordsville IN 47933 Fax 765-362-8817 6400 E* 30th St* Indianapolis IN 46219 Fax 317-541-4104 STEP 1. PERMITTEE INFORMATION Name of permittee as it appears on your Indiana Alcoholic Beverage Permit DBA Permit Number Address number and street city state ZIP code Expiration date month day year Printed name of contact person for permit Emergency contact telephone number Fax Number Employee permit number STEP 2. EVENT INFORMATION A SEPARATE REQUEST MUST BE SUBMITTED FOR EACH EVENT Beginning Ending Day Date Times of catered function AM Start Type or description of event PM To include Sunday Sunday event times if applicable End Exact address of event number and street city state ZIP code STEP 3. FLOOR PLAN SEE STEP 4 2 STEP 4. ACKNOWLEDGEMENT Does not include Sunday The following are guidelines for the approval of an event catered by a supplemental caterers permit 1. The exact address of the proposed catered event must be disclosed upon the application form* 2. A floor plan of the designated licensed premises must be submitted along with the application form* There must be a well-defined premises i*e* a building a tent an enclosure a fenced in area or a roped off area* The exact area from which the alcoholic beverages shall be dispensed must be listed on the floor plan* Areas where minors will be present must be so designated on the plans. No minors shall be allowed within the area where alcoholic beverages are dispensed* Complete Step 3 3. Consumption of alcoholic beverages shall take place on the licensed premises only. There shall be no carry-out privileges. 4. Each applicant shall designate an individual responsible for the event. Such person shall possess an employee s permit and shall be available to the Excise Police during the event. 5. An Excise Officer has the authority to revoke approval of a catered event before or during the event for good cause.