Liquor License Application

Liquor License Application and Agreement

Recitals

WHEREAS, Applicant Name: seeks to obtain authorization to sell, serve, or manufacture alcoholic beverages at the premises described herein; and

WHEREAS, Licensing Authority: is empowered to review applications, impose conditions, and grant or deny licenses in accordance with applicable regulations; and

WHEREAS, Applicant agrees to be bound by the terms and conditions set forth in this application and, upon issuance, by any license granted under these terms.

Applicant Information

Individual   Partnership   Corporation   Limited Liability Company (LLC)   Other:

Ownership / Management

List principal owners, officers, and managers. Attach additional pages if necessary.

Premises and Operations

Retail (on-premises)   Wholesale   Manufacture/Brewery/Distillery   Special Event/Temporary

Scope of Operations

Provide a detailed description of activities to be conducted under the requested license, including the nature of alcoholic beverage sales, points of sale, food service, entertainment, and any third-party operators or concessionaires.

Payment Terms (Application Fee and Related Charges)

Application Fee Amount: $   Payment Method:

Payment Schedule and Additional Fees:

Late Payment: Unpaid fees shall accrue interest at and a late administrative fee of $ .

Term and Termination

Proposed Effective Date:   Proposed Expiration Date:

Notice Period for Termination: Either party may terminate the license or this agreement upon written notice of days for material breach. Immediate suspension or revocation may occur for violations that present an imminent threat to public safety.

Confidentiality

Applicant acknowledges that certain information submitted with this application, including but not limited to financial statements, trade secrets, and personnel records, may be designated confidential by Applicant at the time of submission. The Licensing Authority will treat such information as confidential to the extent permitted by law; however, Applicant expressly acknowledges that the Licensing Authority may be required to disclose records in accordance with public records laws and that such disclosure shall not constitute a breach of this Agreement.

Representations, Warranties, and Certification

By signing this application Applicant certifies under penalty of perjury that all statements made herein are true and complete to the best of Applicant’s knowledge. Applicant further represents that no person with a disqualifying criminal conviction or other statutory disqualification will have control of the business in a manner that would violate applicable licensing standards.

Attachments (Check all attached)

Floor plan and premises diagram   Sample menu (if applicable)   Lease or deed   Fingerprint/background check receipt   Government-issued photo ID

Governing Law; Entire Agreement

This application, and any license issued in reliance on it, shall be governed by the laws of the state of . This document constitutes the entire agreement between Applicant and the Licensing Authority with respect to the matters addressed herein and supersedes all prior communications, representations, and agreements, whether oral or written.

Acknowledgment and Consent

Applicant consents to inspections of the premises, background investigations of owners and principals, and verification of information provided. Applicant understands that issuance of a license is discretionary and may be conditioned upon compliance with additional requirements.

I certify under penalty of perjury that the information contained in this application and accompanying documents is true, complete, and correct. I understand that false statements may result in denial, suspension, or revocation of any license issued and may subject me to criminal penalties.

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