Carroll County Department of Community Development

Transcription

1 carrollcountyga.com/section/community_development/ Application for an Alcoholic Beverage License ***Print or Type clearly. Illegible applications will not be processed. After Pre-Application Conference, return Application to Artagus Newell, Zoning Administrator*** Business Name: Corporation Name: If corporation is a DBA (Doing Business As), use the exact name as it should appear on the Alcoholic Beverage License. Note: When applying for the State of Georgia Alcohol License, use the same Business Name as listed above. Location of business for which application is being made City: State: Zip: Business Phone: ( ) Licensee s Phone: ( ) Licensee s Mobile Phone: ( ) Licensee s Address: Will the proposed outlet have live entertainment? Yes No If yes, describe how many times per week and what type of entertainment in detail: TYPE OF ALCOHOLIC BEVERAGE LICENSE REQUESTED (a separate application and license fee is required for each license. Example: A convenience store selling beer and wine must pay $1200 for the license fee): Malt Beverages, Wholesale $2,000 Malt Beverages, Retail Package $600 Malt Beverages, by the drink for consumption on premises $900 Wine, Wholesale $600 Wine, Retail Package $600 Wine, by the drink for consumption on premises $700 Distilled Spirits, Wholesale $3,500 Distilled Spirits, by the drink for consumption on premises $4,500 Licensed Alcoholic Beverage Caterer $250 Farm Winery $100 Special Event Alcohol Permit $50 per day Employee Permit $25 Hotel-Motel in Room Service Permit $300

2 TYPE OF OWNERSHIP Individual Partnership Corporation Other (specify: ) **If Other, complete information in Item 1(b) as if applicant were a corporation A. If individual, full name and legal address of owner: Name: B. If corporation, corporation name: Name, percentage interest, and legal address of principal stockholders and corporate officers (attach additional sheets if necessary): City: State: Zip: C. If partnership, partnership name:

3 D. Full name and residential address of the named licensee (a) individual (b) principal officer/employee Name: E. For Partnerships, each partner shall join as an applicant for the license and each partner must meet the qualifications of an individual licensee. Each partner shall be required to have a criminal history check and be fingerprinted. Name: Name: Name: If the named licensee, any partner(s), the corporation or any corporate officer has any ownership in any other licensed alcohol beverage business, give business name, business location, and all other pertinent details: On behalf of the named licensee, provide three (3) personal references (not to include relatives) who are responsible, reputable adults, business or professional men or women, who have known the named licensee during the past three (3) years. Name: Address: City: State: Zip: Relationship to Applicant: Name: Address: City: State: Zip: Relationship to Applicant: Name: Address: City: State: Zip: Relationship to Applicant: Has the applicant(s) been denied or had revoked, within the past five (5) years preceding this application, any license to sell alcoholic beverages issued by any governmental entity? Yes or No (with check boxes) Applicant(s) acknowledge and understand that the license, if granted, is NOT transferable to any other individual, partnership, corporation, or entity. Yes or No (with check boxes)

4 carrollcountyga.com/section/community_development/ Criminal History Consent Form *Note - Each named partner and/or corporation member must complete this form. I hereby authorize Carroll County to receive any Criminal History Record information pertaining to me which may be in the Files of any State or Local Criminal Justice Agency. Full Name: LAST NAME FIRST NAME MIDDLE NAME Social Security Number: - - Race: Sex: Date of Birth: / / Signature: To be completed by authorized agent: Record Found (If criminal record is found, return with this signed form) No Record Found Signature of Authorized Agent: Date: Sworn to and subscribed before me on this day of,. Notary Seal: Signature: My Commission Expires:

5 carrollcountyga.com/section/community_development/ GAPS Confirming of Fingerprinting *Note - Each named partner and/or corporation member must complete this form. Applicant s Full Legal Name: To be completed by authorized agent Date Applicant Registered Online with GAPS: Paid by: Visa MasterCard Check Cash Date Fingerprinting Performed at GAPS location: Date Criminal History Verified with GAPS: Record Found No Record Found Criminal History Waiver Required for Licensing Authorization: Yes No **All partners are required to have a criminal history check and be fingerprinted, and must meet qualifications of an individual licensee. ** Has the licensee, any partner(s), the corporation, or any corporate officer been: a. Convicted within the last two (2) years of any felony or any misdemeanor involving moral turpitude? Yes or No with check box b. Convicted of any other misdemeanor within the past two (2) years? Yes or No with check box c. Convicted of selling alcohol to a minor within a three (3)-year period preceding this application? Yes or No with check box If the answer to any portion of this question is yes, describe and give dates of occurrences for each individual conviction (attach additional information as necessary): Authorized Agent Signature: Date:

6 E-VERIFY EXEMPTION JULY 2013: PRIVATE EMPLOYER AFFIDAVIT PURSUANT TO O.C.G.A (d) By executing this affidavit, the undersigned private employer verifies that it is exempt from compliance with O.C.G.A , stating affirmatively that as of JULY 1, 2013, the individual, firm, or corporation employs fewer than ten (10) employees and therefore, is not required to register with and/or utilize the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A IF THE BUSINESS HAS LESS THAN 10 EMPLOYEES SIGN BELOW: Name of Exempt Private Employer: Signature of Exempt Private Employee/Agent: I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on, in, [MONTH] [DAY] [YEAR] [CITY] [STATE] Signature of Authorized Officer or Agent Printed Name and Title of Authorized Officer or Agent **ThIS AFFIdAvIT IS FOr USe FrOM JUly 1, notary Seal: Sworn to and subscribed before me on this day of,. Signature: My Commission Expires: Last Updated: 7/1/2013

7 carrollcountyga.com/section/community_development/ Authorization of Property Owner THIS FORM IS TO BE COMPLETED ONLY IF APPLICANT AND OWNER ARE NOT THE SAME PERSON(S). Applicant is person submitting the land use application. Owner is the property owner. Please type or legibly print. Property Address: City: State: Zip: Applicant Name: Address: Phone: City: State: Zip: [OWNER S NAME], personally appeared before me, the undersigned officer, duly authorized to administer oaths in the State of Georgia and, having been duly sworn, sets forth the following statements for the purpose of being granted a change in land use under the Ordinances of Carroll County: I affirm that I am the owner of the property that is the subject of the attached application, as shown in the records of Carroll County, Georgia. I authorize the person named above to act as applicant in the pursuit of a change in land use of this property. FURTHER AFFIANT SAYETH NOT. I declare under penalty of false swearing that the above is true and correct. This day of,. AFFIANT (signature) Notary Seal: Sworn to and subscribed before me on this day of,. Signature: My Commission Expires: Last Updated: 7/1/2013

8 Alcoholic Beverage License Application Submittal Requirements INSTRUCTIONS: A pre-application conference must be scheduled prior to submittal of an application. Every question must be answered fully and correctly. If the space provided is not sufficient, answer the question on a separate sheet and indicate in the space that a separate sheet is attached. When completed, it must be dated, signed and verified under oath by the applicant and filed in person by the applicant with the Carroll County Department of, 423 College Street, Carrollton, GA All supporting documentation and a certified or cashier s check for the required non-refundable application fee must be included. A license issued to an individual shall be issued in the name of the individual. A license issued to a partnership shall be issued in the name of the partnership and in the name of one of the partners who shall be the named licensee. A license issued to a corporation having as its principal business the same of alcoholic beverages shall be issued in the name of the corporation and the name of the majority stockholder or a principal officer of the corporation primarily responsible for the operation of the licensed premises; and, such officer or employee shall be the name licensee. No Post Office boxes shall be listed in lieu of a physical licensed location. Due to the time needed for review by various departments, allow a minimum of two (2) weeks for processing and determination of approval. Please note the processing time may and can be extended so that all necessary reviews can be completed (including outside agencies). No license shall be issued until all approvals have been granted. This license, if granted, is a privilege. If it is determined that any information submitted is falsified or omitted in any aspect, the license is subject to immediate suspension and ultimate revocation, if seen fit by the Department of and Board of Commissioners, respectively. There shall be no refunding of any application or permit fees should this occur. Additional Requirements Cashier s or certified check for the non-refundable application fee A valid Carroll County Occupational Tax License A copy of the deed to the premises to be licensed, if owned by the applicant A copy of the lease agreement covering the premises to be licensed, if leased by the applicant In the case of a partnership, a copy of the partnership agreement In the case of a corporation, a copy of the articles of incorporation In the case of a business entity other than a corporation or a partnership, a copy of the articles of organization and the operating agreement or equivalent

9 A current stamped certificate from a registered surveyor which shows a scale drawing of the premises and the location at which the applicant desires to operate an alcoholic beverage outlet and which shows, in linear foot measurements where appropriate, such location s compliance or noncompliance with the provisions of the Alcoholic Beverage Ordinance A seating chart showing the number of tables and permanent seating at each (bar stools are not considered to be permanent seating) If applicable, approval from the Department of for any new construction, renovations, remodeling, etc., at the premises to be licensed If applicable, an approved site plan from the Department of for the location of the premises to be licensed If applicable, a Carroll County Health Department Food Service Permit or Department of Agriculture Permit and any other applicable local, state, or federal permits, etc., required for a food service establishment Please note that establishments serving alcohol and seating 100+ persons are required to contact the State Fire Marshall for inspection and approval of the premises. The State Fire Marshall can be contacted at (404) The named licensee, and all other persons otherwise required, should register and submit themselves for fingerprinting and background check(s) at a certified GAPS location, as provided for in the Alcoholic Beverage Ordinance. Staff will verify with the Georgia Department of Revenue regarding the applicant s (s ) ability to obtain an Alcoholic Beverage License. Applicant(s) shall provide a copy of a valid driver s license, or other valid and acceptable state or federally-issued photo identification. If born anywhere other than the United States, please provide proof of Naturalization. Note: Green card residents are ineligible to apply as the named licensee for an Alcoholic Beverage License.