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Date Requested:    _____________________________________________________

Hours:                  _____________________________________________________

Type of Function : ______________________________________________________

Number of Guests Attending: _____________________________________________

Owner's/Renter's Name: _________________________________________________

Address: ______________________________________________________________

Home Telephone Number: ________________________________________________

Work Telephone Number: ________________________________________________

Date Request Made: ____________________________________________________

Signature:  ____________________________________________________________

Deposit Paid :  ____________________________       Amount: _________________

Deposit Returned :  ________________________        Amount: _________________

Comments:  ___________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

3/25/99