APPLICATION FOR LIQUOR LICENSE Date I,, (Print full name) do hereby make an application for a City of Festus liquor license. Type of license requested: package picnic full restaurant Sunday 5% beer/wine Applications for original package license must include an affidavit by the individual owner, all of the partners, or managing officer of the corporation containing the type of business presently engaged in or in conjunction with which the license shall be used and further stating that the applicant has and at all times keeps in his/her place of business, a stock of goods having an invoice value of at least one thousand dollars ($1,000.00) exclusive of fixtures and intoxicating liquors. Proposed name of business: Address of business City / State / Zip Type of ownership: Proprietorship Partnership Corporation Other (explain) Name of
Name, address, phone number and date of birth of all partners or corporate officers: Name Address Phone Number Date of Birth Purchase building Renting Terms of business agreement: Purchasing Business Other (explain) If renting, who owns the building? Remarks: Is this location within one hundred (100) feet of a school or church? Sales tax ID # A copy of your State Tax License must be attached, also please use the back of this application to detail a complete description of the business operation. Include estimated revenues from liquor sales and food sales. A Certificate of No Tax Due must accompany this application. A complete description of the plans, specifications, and fixtures in the proposed place of business if new location, or change in previous establishment is required to be attached, along with the cost value on inventory other than intoxicating liquor.
APPLICATION INFORMATION This form must be filled out in its entirety by all persons involved in the business, either as partners, owners, managers etc. whether they are actively involved in the operations. The City of Festus does not discriminate and will not withhold any application due to age, sex, race or religious preference of the applicant. Full name: (include maiden name, aliases, all names used in previous marriages, and all previous names) Title in organization: Social Security # Date of birth: Place of birth: Sex: Drivers license Number: State: Telephone numbers: (home) (work) Other employment: Name of employer: Address: _ If applicant is not a corporation, give the names and addresses of employers for a period of (5) five years prior to the application. Employer: Employer: Address: Employer: Employer: Employer: Address: Employer: Employer: Employer; Address: Employer:
APPLICATION INFORMATION CONTINUED The following questions must be answered and initialed. Will any distiller, wholesaler, winemaker, brewer, supplier or coin operated, commercial, manual or mechanical devices, or the employee, officers or agents thereof, have any financial interest in the retail business of applicant for the sale of alcoholic beverages, or C.O.L., will the applicant either directly, borrow or accept from any such persons equipment, money, credit or property of any kind except ordinary commercial credit for liquor sold? Are you a citizen of the United States? Were you naturalized? Have you ever been convicted of or pleaded guilty to any felony or any misdemeanor related to the sale of alcoholic beverages? Have you ever been convicted of a felony? Have you ever been convicted of or pleaded guilty to a violation of any state liquor license laws? Have you ever held or been party to a liquor license that was revoked? Are you a qualified legal voter of this state? (Proof of voter registration in the State of Missouri is required.) Are you a tax- paying citizen of this state? (Proof of paid taxes (personal property and real estate tax receipt required.)
Have you ever previously owned or been a party to, in any manner, a liquor license establishment? (If yes, please indicate on the back of this application the name of the establishment, dates and the nature of your affiliation, the location and type of license held.) Explain any YES answers on the back of this application. Include dates, locations, dispositions and any other pertinent information..
STATEMENT OF UNDERSTANDING The following must be initialed by the applicant and witnessed by the City of Festus. 1) I understand that I must submit to fingerprints and photographs by the Festus Police Department and that the fingerprints and the photographs may be used in the processing of my application. I also understand that the Festus Police Department retains sole ownership of the fingerprints and photographs and may be used by them for whatever legal uses they may have. 2) I understand that photographs of the exterior and interior of the establishment must be provided with my application. 3) I understand that I must obtain a complete background criminal and traffic check from the Missouri State Highway Patrol and make the results known to the Mayor, City Council and those persons who have a need to know prior to the receipt of a liquor license. 4) I understand that any falsehoods or omissions on this application may be the cause for the city to refuse or revoke the liquor license. 5) I understand that all partners, agents and owners must submit the application, fingerprinting and photographs prior to any license being issued. 6) I, understand that a minimum of two weeks is required to process the license and screen the applicant. STATE OF MISSOURI ) ) SS. JEFFERSON COUNTY ) Comes now of lawful age, being first duly sworn upon oath, and states that he/she has read the foregoing Application and fully understands the same, and that the answers and statements given by him/her are true and correct. Further, applicant agrees to comply with the provisions of the Code of the City of Festus, Missouri relating to the manufacture, brewing, sale and distribution of intoxicating liquor and malt liquor. Signature Date
Subscribed and sworn to before me this day of, 2012. My term expires: Notary Public