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Get City Of Independence Form

Te Expiration Date Complete the following based on location type shown above, when applicable: Business name Property owner Phone Address of event or function Date(s) and time of event Name and Social Security Number of person(s) who will be in active control and management of this event: This permit may be issued only to establishments holding a liquor license to sell intoxicating liquor by the drink at retail and may be for a period not to exceed one hundred twenty (120) consecutive hours.

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