Online Form - Liquor Application

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This form is for the purpose of requesting permission to have alcohol on Council owned or managed premises and public places.

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Name of Applicant*

Residential Address*

Postal Address (if different to the above address)

Home Phone Number

Work Phone Number

Mobile Number*

Email Address*

Contact Person*

Venue or Location*

Date(s)*

Alcohol Availability Time From:*

Alcohol Availability Time To:*

Function Purpose*

Expected Number of Guests*

Alcohol will be:*

BYOSoldProvided

Licensee Name (if Occasional Liquor Licence)

Details of quantities of alcohol to be brought onto site*

Security will be provided by:*

Alcohol may only be taken onto Council owned or managed premises and public places if the following applications have been made and approval granted:

If alcohol is going to be brought on a BYO basis the hirer must apply in writing (using this form) to the Chief Executive Officer. Approval is subject to the discretion of the Chief Executive Officer.
Live entertainment events/venues over 200 patrons are not able to have BYO exemptions under Department of Racing, Gaming and Liquor policy regarding Exemptions to the Liquor Control Act 1988.
Applicants who intend to sell alcohol either direct or indirect (included in the price of a ticket etc.) must gain permission from the Chief Executive Officer, Shire of Wyndham East Kimberley (using this form) then apply for an Occasional Liquor License from the Department of Racing, Gaming and Liquor (Liquor Licensing Division). If approval is granted a copy of the Occasional License and any conditions contained therein must be forwarded to the Shire of Wyndham East Kimberley, at least one week prior to the function with a plan showing the licensed area.

Further to the above, the application must also align with the Shire of Wyndham East Kimberley’s CP/COM 3584 Alcohol Management Policy.

I have read and understand the above Liquor Guidelines*

YesNo

Full Name (By completing this you are formally submitting this form)*

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