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501 Highway 101 N
PO Box 345
Yachats, OR 97498
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I have read and agree to comply with the regulations listed on the reverse side of this form. I further agree that I shall indemnify and defend City, its boards, commissions, officers, agents and employees against any and all liabilities for injury or death of any person or any damage to any property caused by any acts or omissions of (Applicant), applicant’s officers, agents or employees, arising out of the exercise of any right or privilege extended to the applicant under this Application for use of alcohol on City property.
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