Temporary Liquor License

2. Assumption Parish Police Jury
4. TO WHOM IT MAY CONCERN:
   This form will be approved or denied by the Assumption Parish Police Jury at the next available Jury meeting.
6. If approved and signed, the members of the alcoholic permit committee, appointed by the Police Jury of Assumption Parish, Louisiana, to supervise the issuance of parish licenses for alcoholic beverages, have no objection to the issuance of a license for the sale of alcohol.
8. Approved Application must be submitted to:
   Assumption Parish Sheriff Office, P.O. Box 69 Napoleonville, LA 70390
10. Applicant Data
12. Date*
    Date Start Date

    —

    Date End Date
    Enter the date you are requesting the permit for. If applying for a one day permit, put the date in both fields.
14. First Name*
    Enter your first name
15. Last Name*
    Enter your last name
17. Address*
    Enter your address
19. City*
    Enter your city
20. Zip Code*
    Enter your zip code
22. Email Address*
    Enter your email address
23. Phone Number*
    Enter your phone number
25. DBA*
    Enter what organization you are 'Doing Business As'
27. Location of Event*
    Enter address where alcohol will be sold
29. City*
    Enter city where alcohol will be sold
30. Ward*
    Enter the ward alcohol will be sold in
32. Approved By
    Internal Use Only. Enter the name of the juryman whom approved this license.
33. Ward
    Internal Use Only. Enter the ward alcohol will be sold in
35. Notes
    Internal Use Only. Enter any notes pertaining to this permit.
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field