Alcohol License Application

ALCOHOL LICENSE APPLICATION AND AGREEMENT

Applicant Name:    Business / Trade Name:

WHEREAS

WHEREAS, the Applicant seeks the issuance of an alcohol beverage license to engage in the sale, service or distribution of alcoholic beverages at the premises identified in this application; and

WHEREAS, the Licensing Agent (or Licensing Authority) administers application intake, investigation, and preliminary approval under the statutory and administrative requirements applicable to alcoholic beverage licensing; and

WHEREAS, by submitting this application the Applicant agrees to comply with the terms of this Application and Agreement, to pay required fees, and to provide truthful disclosures under penalty of perjury as set forth below.

APPLICANT INFORMATION

Phone:    Email:

LICENSE TYPE & PREMISES

Select license type(s) requested:

Retail - On-Premise Sales    Retail - Off-Premise Sales    Wholesale & Distribution

Is the Applicant the owner of the premises?    Yes    No

OWNERSHIP & MANAGEMENT

Individual    Corporation    LLC    Partnership

BACKGROUND DISCLOSURES

Has the Applicant or any listed owner ever been convicted of a felony related to controlled substances, alcohol, or other moral turpitude?    Yes    No

SCOPE OF WORK

PAYMENT TERMS

Application Fee Amount: $    Annual License Fee (if applicable): $

Late Fee:    Collection and interest on unpaid fees shall accrue as set forth in applicable law and administrative rules.

TERM AND TERMINATION

Proposed License Term Start Date:    Proposed Term Expiration Date:

The Licensing Agent may suspend or revoke any provisional approval or license for cause, including but not limited to fraud in application, substantial noncompliance with applicable law, or threats to public safety. Applicant acknowledges that issuance is conditioned on satisfactory investigation and compliance.

CONFIDENTIALITY

Certain portions of this application may contain proprietary financial information. To the extent permitted by law, such information will be treated as confidential during the investigation and licensing process. By checking the box below, Applicant requests confidential treatment and certifies that the information claimed as confidential is identified.

Applicant requests confidential treatment for identified information.

GOVERNING LAW

This Application and Agreement shall be governed by and construed in accordance with the laws of the State of and any applicable local ordinances.

ENTIRE AGREEMENT; CERTIFICATION

Entire Agreement: This application, together with any attachments, disclosures, fee receipts, and any provisional licensing terms issued by the Licensing Agent, constitute the entire understanding between the Applicant and the Licensing Agent with respect to the subject matter hereof. No amendment shall be effective unless in writing and signed by both parties.

Certification: The undersigned Applicant certifies under penalty of perjury that the information provided in this Application is true, complete, and correct to the best of Applicant’s knowledge. Applicant understands that material misstatement or omission may be grounds for denial, suspension, or revocation of any license and may subject Applicant to criminal or civil penalties.

Floor plan    Proof of ownership/lease    Financial statements    Identification documents

ATTESTATION

The Applicant hereby attests and agrees to cooperate with any investigation, to provide additional documentation upon request, and to abide by conditions imposed as a condition of license issuance. Applicant further acknowledges that approval of this Application does not relieve Applicant of any duty to obtain any other required permits or approvals.

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