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2. Event Date:*
4. Name:*
6. Event Name:*
8. Location Address:*
10. Gross from alcohol sales:*
12. Regulatory fee - 5% of sales:*
14. Less city license fee credit allowed:*
16. Subtotal regulatory fee due: *
18. Penalty for late payment - 5% of line 4: ($10.00 minimum, 25% maximum of line 4)
20. Interest for late payment -8%:
22. Total regulatory fee due: *
24. Signature/Date*
26. Due in Office 14 days after event date

    Remit check or money order payable to:
    City of Georgetown
    c/o ABC Administrator
    100 N. Court Street
    Georgetown, KY 40324

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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

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