2. Applicant Information
4. Applicant Name*
5. DOB
   DOB
   Date of Birth
7. Address:*
9. Phone Number*
10. Mobile
12. Purpose of Request
    Max Length 255 characters
14. Date of Event
    Date of Event
15. Duration of Event
    Duration of Event Start Time

    —

    Duration of Event End Time
    Start and Stop time
17. Alcohol available at event
    -- Select One --YesNoBYOBSellingSupplied
18. Inventation only
    -- Select One --YesNo
20. Name of contact during the event if different from aboce applicant:
22. Phone Number
23. Mobile:
25. Fees for Certified Peace Officers:
    Big Spring Police Officers and Howard County Sheriff Deputies charge $30.00 an hour per officer
27. Minimum of 2 officers are required at all times
    If requesting a certain officer(s) or deputies please specify the name(s):
29. Requested duties and Responsibilities for officers to provide (Example: inside building or outside building walking around):
31. FACILITY INFORMATION
    Where event is being held
33. Facility Name
35. Address
37. Signature of Applicant:
38. Date:
    Date:
42. Depertment Use only
44. Request Approved
45. Request Denied
47. Request Processed Date and Time
    Request Processed Date and Time

    Request Processed Date and Time
Leave This Blank:


48. Print Only

* indicates a required field