HomeMy WebLinkAboutForm - Application for Private Host Permit (Fillable)DEPARTMENT OF LIQUOR CONTROL COUNTY OF HAWAI‘I
Hawai‘i County is an Equal Opportunity Provider and Employer
Hilo Lagoon Centre, 101 Aupuni St., Unit 230, Hilo, Hawai'i, 96720 * Phone: (808) 961-8218 * Fax: (808) 961-8684
E-Mail: cohdlc@hawaiicounty.gov
APPLICATION FOR PRIVATE HOST PERMIT
Pursuant to Rule 3-2-D-10 of the Rules and Regulations of the Liquor Commission of the County of Hawai‘i, application
is hereby made for a Private Host Permit, as follows:
Date: Time:
Name of Host/Guest: Place/Room:
Host will provide:
Beer:
Wine:
Distilled Spirits:
Live Entertainment
(Describe):
Licensee:
By:
(Signature)
Name:
Title:
Date:
Phone No:
Fax:
E-Mail:
PERMIT
Your application for a Private Host Permit is approved and subject to the following conditions:
1.The private host may bring liquors in accordance to the Kind of license held and entertainment shall be in
accordance to the Category of license held.
2.All unused liquors shall be removed from the premises.
3.The premises remains licensed and activities shall be in compliance to the liquor laws.
By:
Director, Department of Liquor Control
Date:
SPECIAL INSTRUCTIONS: To accommodate late requests made by patrons after our office hours, applications
may be submitted after hours (4:30 p.m.) by faxing this application to (808) 961-8684 within 30 minutes of the guest’s
reservation.