VILLAGE OF MICHIANA
COMMUNITY ROOM USE APPLICATION
Please complete the following application, sign it, and return it along with a check in the proper amount made payable to “Village of Michiana”. Once this application is approved by the Village Council, your lease will be entered onto the calendar. The Village Council meets on the third Monday of each month.
Private Party Not-For-Profit Organization
Name: ________________________________________________________________________________________________
Local Address: _______________________________________________________________________________________
Date of Party: ______________________________
Reservation Time: _______________________________ Termination Time: _________________________
Type of Party: ___________________________________ Deposit Amount: ___________________________
Rental Fee: $250 rental fee / $300 deposit*
(*deposit shall be refunded if room returned to original condition)
The Community Room will be available in a ready-to-use condition ______ hours prior to reservation time. You must obtain prior approval for all decorations.
You must contact the Michiana Village Police Department (269.469.1884) to arrange for access to the Community Room. The Village Clerk will furnish the Police Department with copies of all rentals. The applicant acknowledges and agrees to assume full responsibility for the premises during the reservation period and shall assume responsibility to insure the safety of guests.
The applicant agrees that in reference to a not-for-profit party, a special event one-day liquor license must be obtained from the Michigan Liquor Control Commission.
Note: You are responsible for cleaning the hall after its use. In the event you fail to return the hall in clean condition, the Village may have it cleaned and charge the expense to you.
_________________________________ __________________________________ ________________________
Council Approval Date Deposit Refund Check # and Date
** Rental of the Village Community Room is limited to Michiana Village residents only. **
Rev. 05.04.2009 / VOM
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