HomeMy WebLinkAboutFLI-08-2016-076291.TIF •
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.$ i., Application for Temporary Fo 6 d Estaoris7�men ermi
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H i. (To be completed for each booth)
.r' (NOTE: As of August 17, 200' a $75.00 Fee Applies)
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Establishment Name Ilich larc_ Un 4ecL, Ke od sf Church
Operator Name Lt ' \a " - 1 t a n - i 1 I peal f',, 1 r p`_^
Mailing Address I oa a 13+t) sty -F Pi Nl E I-r Cko rt9 I c a g&o I
Telephone(day#) 8 8-c93g-14-186, -1-r-i,L I Sag-Sao-as Lt �I - di a I
Name of EvenrFestival/Carnival; etc.4�kor Alum can Leg' 0n Fa I r
Dates & Times of Operation , 1 US 1 3 r- 50 E t ' be r ✓Th c 0 l "o
Please Indicate Setup Completi n Time i rust- 315r 5 WO prn
Signature of applicant: L [ry / dir
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Menu: Attach menu or list all food items to be prepared or serve,.
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All foods sold at this Temporary Food Establishment must be prepared and cooked at the permitted site except
foods prepared in another establishment permitted under 15A NCAC 18A .2602.
Food Prepared and Cooked On-Site
In the table below, check the procedures for each food which will performed on site in the Temporary Food
Establishment.
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Foods Prepared and Cooked Mtteyfl �v I I p(-/,�am
Name of Permitted Establishment: r j
NC DENA Establishment ID#
Establishment Owner/Manager c ),2SS¶Pat r5
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Establishment Address a tlpRc� '{ S t SW) I-c (3 / Ma Qs/(Oi
Establishment telephone# gag_3°8- 4a it-4
In the table below list all foods prepared in the permitted establishment and check all procedures performed
there.
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Lips sources of 1 eat pool , od and shellfish:
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State method of storing and disposing of wastewater:
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Booth sketch:
Draw the food booth, identifying and describing all equipment, including handwash facilities, equipment
washing facilities, cooking equipment,refrigeration,worktables, storage,hot and cold holding units,water
source and storage. Describe the floor,wall and ceilin surfaces of the booth.
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n�1 IRS Department of the Treasury
��p``77//JJ Interne' Rovenua Service
In reply refer tot 0244374788
CINCINNATI OH 45999-0038 Jan . 22 , 2014 LIR 147C 0
56- 1379937 000000 00
00001843
BODC: TE
HIGHLAND UNITED METHODIST CHURCH
1020 12TH STREET PL NE
HICKORY NC 28601-4128
025428
Employer Identification Number : 56 1379937
Dear Taxpayer :
Thank you for your inquiry of Jan . 07, 2014 .
Your Employer Identification Number ( :IN) is 56-1379937 . Please keep
this letter in your permanent records . Enter your name and EIN on all
federal business tax returns and on r =fated correspondence .
If you need forms , schedules, or publ cations , you can obtain them by '
visiting the IRS web site at www . irs . rov or by calling toll free at
1-800-TAX-FORM ( 1-800-829-3676) .
Please call our toll-free telephone number at 1-800-829-4933
with any questions you may have .
You also can write to us at the address shown at the top of this
letter ' s first page .
When you write to us , please attach this letter and , in the spaces
below, give us your telephone number ith the hours we can reach you
in case we need more information . You also may want to keep a copy of
this letter for your records .
Telephone Number C ) Hours
We apologize for any inconvenience we ' lay have caused you , and thank
you for your cooperation .
9/S 91.636-IME-9Z9 ON (Alu>1o!H SdSf WV Ob Ob L L gLOZ/ZL/Onv
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Highland Highland United Methodist Church
1020 12th Street Place NE Phone: (828) 327-8066
Hickory, NC 28601 Fa : (828) 569-1874
E- ail: highlandumc74@yahoo.com
W•bsite: www.highlandumchickory.com
August 10, 2016
To Whom It May Concern,
This letter is to inform you that 100% of the moneys rceived from the fair booth will be
going to our Youth group here at Highland United Met odist Church.
•
•
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Sincerely,
Vat/
Rosemary ertzel
Church Treasurer
9/9 96-9E-92 ON 'AJO)10IH - SdSn At/op,or•L l B IOZ/Z 1/6nv
4 - CATAWBA COUNTY
i� O`er 100A SOUTHWEST BLVD
NEWTON, NORTH CAROLINA 28658 RECEIPT
d gyp/►a PHONE: 828.465.8399
Iwa1-1
sv, kt Tuesday,August 30, 2016
42 SM
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1$[}�. sm www.catawbacountync.gov
PAYOR:
HUFFMAN, THAD& LINDA
PAYMENTS
TRANSACTION NUMBER: TRC-808417-30-08-2016
PAYMENT DATE : 08/30/2016
PAYMENT TYPE: Check 6011
INVOICE NUMBER FEE NAME FEE AMOUNT
08-16-332151 Temporary Food Establishment $75.00
Fee
TOTAL PAYMENTS : $75.00
FLI-08-2016-076291
CASE TYPE: Food & Lodging Institutions WORK CLASS: 73 - Temporary Food Establish]
SITE ADDRESS: 1127 US 70 HWY, NEWTON NC 28658
Applicant HIGHLAND UNITED METHODIST CHURCH, 1020 12TH ST PL NE, HICKORY 28601
F:NONE
Paid By THAD&LINDA HUFFMAN, 6161 WILTSHIRE DR, HICKORY NC 28601
C:8282562759
** NO PEOPLESOFT ACCOUNT ASSIGNED **
receipt 08/30/2016 13:16 Page 1 of 1