Plcb Special Permit Application Form – Fill Out and Use This PDF

(SEE INSTRUCTIONS PAGE 2 OF 2)

PAGE 1 OF 5

The undersigned hereby applies for a SPECIAL OCCASION PERMIT for:

1.a. Nonconsecutive dates of:

Mo./Date/Year	Mo./Date/Year	Mo./Date/Year	Mo./Date/Year	Mo./Date/Year	Mo./Date/Year
____ / ____ / ____	____ / ____ / ____	____ / ____ / ____	____ / ____ / ____	____ / ____ / ____	____ / ____ / ____
b. Consecutive dates from:		to

3. TYPE OF ENTITY

(SEE ATTACHED FOR QUALIFYING ELIGIBLE ENTITIES)

(INSERT TYPE FROM LIST)

ADDRESS(STREET, RURAL ROUTE, P.O. BOX NO.)(POST OFFICE)(STATE)(ZIP)

											PA
NAME OF MUNICIPALITY	TYPE OF MUNICIPALITY									INC.	COUNTY
			CITY
					BORO		TWP.			TOWN

5.NAME AND ADDRESS TO WHICH PERMIT SHOULD BE MAILED, IF DIFFERENT FROM ABOVE APPLICANT

6.NAME AND ADDRESS OF PRIMARY ORGANIZATION, IF ANY

7.LIST LOCATION OF PREMISES OR AREA TO BE LICENSED

STREET, RURAL ROUTE, P.O. BOX NO.

CITY, BOROUGH, TOWNSHIP, INC. TOWN

COUNTY

OUTSIDE AREA

8.	ARE PUBLIC STREETS, ROADS OR THOROUGHFARES BEING CLOSED FOR THIS EVENT?			YES			NO
	If ‘yes,’ attach written approval from municipal authority.
9.	HAS A SPECIAL OCCASION PERMIT EVER BEEN GRANTED TO THIS ORGANIZATION?				YES			NO
	If ‘yes,’ give License Identiication Number LID -

If ‘yes,’ give date (Months/Year)

Give NUMBER OF PERMITS this calendar year

DO NOT WRITE BELOW THIS LINE

CO/MNCP _ _ - _ _ _ ZIP _ _ _ _ _ - _ _ _ _

EVENT CO/MUNCP _ _ - _ _ _

PAGE 3 OF5

INSTRUCTIONS

This form is to be used to apply for a Special Occasion Permit for use at a special event including, but not limited to bazaars, picnics and clam bakes. The event must be one which is used by the applicant as means of raising funds for itself.

1.A fee of $30.00 per day MUST accompany this form. If the applicant is a bona ide sportsmen’s club, non-proit agricultural association or museum or performing arts facility and this is the FIRST Special Occasion Permit application iled with the Board, the fee is $85.00 for the irst day and $30.00 for each subsequent day.

2.This form and fee MUST be iled at least 30 days prior to the date of the event.

3.All questions must be answered, even if the answer is “NONE” or “NOT APPLICABLE.” This form MUST have an original signature.

4.Applications from an auxiliary group must be signed by an oficer from the primary organization. If the application is from a church or synagogue AND is signed by the minister, priest, or rabbi, question 17 (Resolution) does not have to be completed.

5.Applications from afiliated lodges or subdivisions of nationally chartered veterans' organizations MUST submit copy of documentation proving afiliation with national veterans.

6.Applications from fraternal beneit societies MUST submit proof that society is licensed to do business in Pennsylvania.

7.Applications from a non-proit organization conducting a regatta or a family-oriented celebration MUST submit proof that the applicant is a non-proit organization as deined under Section 501(C)(3) of the Internal Revenue Code of 1986 [Public Law 99-514, 26 U.S.C. §501(C)(3)].

8.Applications from a non-proit organization whose purpose is to protect the architectural heritage of boroughs MUST submit proof that the applicant is a non-proit organization as deined under Section 501(C)(3) of the Internal Revenue Code of 1986 [Public Law 99-514, 26 U.S.C. §501(C)(3)], AND MUST submit a copy of the borough's municipal resolution recognizing the applicant as such an organization.

PERMITS ARE NOT TRANSFERABLE AND CANNOT BE RENEWED. NO ALTERNATE RAIN DATES MAY BE CONSIDERED. IF YOU REqUIRE ASSISTANCE IN COMPLETINg THE APPLICATION, CALL THE LICENSINg INFORMATION CENTER AT (717) 783-8250.

SEND THE APPLICATION PACkET TO: PENNSYLvANIA LIqUOR CONTROL BOARD

BUREAU OF LICENSINg

P.O. BOx 8940

HARRISBURg, PA 17105-8940

PAGE 4 OF 5

ELIgIBLE ENTITIES LIST

Special Occasion Permits may be issued:

A.For not more than six (6) consecutive or non-consecutive days during the calendar year. One permit may be issued per calendar year to the following applicants:

1)Hospital

2)Church or Synagogue

3)City of the 3rd class.

4)Library

5)Volunteer ire company or ambulance company or rescue squad.

6)Non-proit agricultural association in existence for at least 10 years.

7)Bona ide sportsman’s club in existence for at least 10 years.

8)Nationally chartered veterans' organization and any afiliated lodge or subdivision of such organization.

9)Fraternal beneit society licensed to do business in Pennsylvania and any afiliated lodge or subdivision of such Fraternal Beneit Society.

10)Unit of a nationally chartered club, which has a club liquor license.

11)Non-proit organization as deined by Section 501(c)(3) of the Internal Revenue Code of 1986 whose purpose is to protect the architectural heritage of boroughs or a township of the 2nd class and which has been recognized as such by a municipal resolution.

12)A non-proit corporation that operates an arts facility or museum.

13)A nationally accredited PA non-proit Zoological Institution licensed by U.S. Department of Agriculture.

14)Non-proit organization as deined under Section 501(c)(3) of the Internal Revenue Code of 1986 conducting:

a.a regatta on State park grounds located in a city of the 2nd class, or

b.a family-oriented celebration as part of Welcome America in a 1st class city on property leased from that city for a period of more than 50 years.

NOTE:	Organizations conducting a regatta may install a security fence or similar enclosure around the boundary of the State
	park or a portion thereof and charge an admission fee not to exceed $5.00 per day.

15)Club licensee that as of 12/31/02 has been in existence for at least 100 years.

16)A non-proit organization as deined under Section 501(c)(3) of the Internal Revenue Code of 1986 whose purpose is to raise funds for the research and treatment of cystic ibrosis.

17)A non-proit organization as deined under Section 501(c)(3) of the Internal Revenue Code of 1986 whose purpose is to educate the public on issues dealing with watershed conservation.

18)A non-proit organization as deined under Section 501(c)(3) of the Internal Revenue Code of 1986 whose purpose is to provide equine assisted activities for children and adults with special needs.

19)A non-proit economic development agency in a city of the 2nd class with the primary function to serve as an economic generator for the greater southwestern Pennsylvania region by attracting and supporting ilm, television, and related media industry projects and coordinating government and business ofices in support of a production.

20)A county tourist promotion agency as deined in Section 3(1) of the act of April 28, 1961, known as the "Tourist Promotion Law"

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