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.

   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.

   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

   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