Liquor License Application

Liquor License Application.pdf

Download PDF • 61KB

ANNUAL LIQUOR LICENSE APPLICATION

The undersigned herby makes application for the issuance of a village liquor license for the term ending April 30 of the following year, and hereby certifies to the following facts:   (type or print).

DATE: _______________________

BUSINESS NAME: ______________________________________________________________________________

BUSINESS ADDRESS: ___________________________________________________________________________

BUSINESS PHONE NUMBER (on premise)______________________________ Corporation:         Yes               No

Business  SS# or Federal Identification Number: _____________________________________________________

Type of Business: _________________________________ Class of License desired: ________________________

(Class A: On premise, retail sales. Class B: On premise, retail sales where food is also served.

Class C: Package Liquor. Class D: One Day Event License)

APPLICANT /OWNER INFORMATION  (All owners must be listed):

Owner 1: _________________________________________________U.S. Citizen:       Yes            No

Address: __________________________________________________________________________

Date of Birth: _________________ Place of Birth: _______________ Phone No._________________

Owner 2: _________________________________________________U.S. Citizen:       Yes            No

Address: __________________________________________________________________________

Date of Birth: _________________Place of Birth: _______________ Phone No. _________________

Owner 3: _________________________________________________U.S. Citizen:       Yes            No

Address: __________________________________________________________________________

Date of Birth: _________________Place of Birth: _______________ Phone No. _________________

Applicant, if different than owners listed above: __________________________________________

Applicant Address: __________________________________________________________________

Date of Birth: _________________Place of Birth: _______________  Phone No: _________________

Please respond to the following questions:

1.      Is the property leased from a landlord? ________________   (If yes, please provide, on a separate sheet of paper, the building owners name, address, phone number and date the lease expires)

2.      Have you ever been convicted of a felony? ________________________________________

3.      Have you ever been convicted of a gambling offense? _______________________________

4.      Have you ever had any previous liquor license, local or state, of which you were a part of, revoked? ___________________________________________________________________

5.      Have you ever been convicted of a violation of any federal or state law concerning the manufacture, possession, or sale of alcoholic liquor or forfeited a bond to appear in court to answer charges for any such violation? ___________________________________________

6.      Are you currently serving in an elected position or as a law enforcement official in any governmental entity? ___________ If yes, please list title and type of government entity.

___________________________________________________________________________

7.      Were you born outside of the United States of America? _____________________________

8.      Will the business be conducted by a manager or Agent? _______________  If yes, please provide the name, address and phone number of such manager or agent. ______________________________________________________________________________________________________________________________________________________________

9.      Will you attempt to prevent rowdiness, fights, and disorderly conduct of any kind and immediately notify the Sheriff’s Department if any such events take place? _________________

10.   Will you and all your employees refuse to serve or sell alcoholic liquor to an intoxicated person or to a minor? _____________________________________________________________________

11.   Will you familiarize yourself with all laws of the United States, State of Illinois, and ordinances of the Village of Bishop Hill, pertaining to the sale of alcoholic liquor and abide by all? ___________

PLEASE PROVIDE THE FOLLOWING DOCUMENTS:  1. Photocopy of last year’s State Liquor License

2.  Certificate of Insurance for current year (not the Policy Declaration page).

I, the undersigned, under penalties of perjury, swear or affirm that the above information is true and correct.  Should any of the above information change, I agree to notify the Liquor Commissioner within seven (7) days of the change.

Dated ________________________________ Printed Name _______________________________________                               

                                                                                    Signature ___________________________________________