Liquor Control Mattew P. Kasten
Commissioner President
APPLICATION FOR LOCAL LIQUOR LICENSE
This application requests information required under Brighton Village Code (as amended). Failure to provide any applicable information will result in the automatic denial of a license. The acceptance of the fee herein does not constitute approval by the Village of Brighton of the Application for a liquor license. If this Application is denied, all fees will be refunded.
NAME OF BUSINESS THAT WILL BE SELLING ALCOHOL:
Application for CLASS __________ Liquor License | Fee Tendered: $ |
Class A-Taverns | $800.00 |
Class B1-Package Liquor Stores | $400.00 |
Class B2-Sunday Sales | $750.00 |
Class C-Per Event | $25.00 |
Class D-Restaurants | $800.00 |
NOTE: Local liquor licenses allow the licensee to sell or offer for sale alcoholic liquor only at the premises specified in the license. Each license shall terminate June 30th from the date of issuance. Renewal application shall be submitted at least 21 days prior to expiration.
**Failure of licensee to comply with the liquor control requirements and restrictions set forth in the Village Code may result in revocation or suspension of the liquor license.
FOR OFFICE USE ONLY Date Received: ____________________ | |
Denied: ___________________ Granted: __________________ Date: _____________________ | License#: Date Issued: Date of Expiration: |
Signature of Liquor Control Commissioner: | Date: |
Part A. GENERAL APPLICANT INFORMATION: TO BE COMPLETED BY APPLICANTS |
Name of Applicant(s) _________________________________________________________________________________
_________________________________________________________________________________
Business Type: ______________________________________________________
Check Appropriate Answer:
___ New Application
___ Renewal Application
Current County Liquor License #_____________________________________ Date first Issued: ___________________
Current Illinois Liquor License #______________________________________ Date first Issued: ___________________
NOTE: Renewal applicants need only complete the sections of this application which have changed since the original or last renewal application was submitted.
Statue of Business:
___ Sole Proprietorship-Date Assumed Name Filed: _________________________________________
____Partnership-Date of Formation: ______________________________________________________
____Illinois Corporation-Date of Incorporation: _____________________________________________
____Foreign Corporation-State of Incorporation: ____________________________________________
Date Qualified to do Business in Illinois: _________________________
____Limited Liability Company-Date Formed: ______________________________________________
____Club/Association-Date Formed: ______________________________________________________
Stated Purpose: ______________________________________________
Summary of Club activities this past year: ________________________
______________________________________________________________________
Address of Business at which liquor will be sold:
_____________________________________________________________________Phone: ____________________
Address of any other premises within Brighton at which liquor may be warehoused:
______________________________________________________________________________
Ownership of Premises where the business will operate: _________________________________________________
(If Applicant does not own the property, a copy of the current lease must be attached and cover the term of license.)
Business website: ___________________________________ E-mail address: ____________________________________
Hours of Business Operation:
Sunday | Monday | Tuesday | Wednesday | Thursday | Friday | Saturday |
Federal Employer Identification Number: ____________________________________________________________
Illinois Business Tax (Sales Tax) Number: ____________________________________________________________
Insurance Policies covering the operation of the business and the business premises:
Insurance | Type of Policy | Policy # | Co. Phone # |
**New applicants attach a copy of the floor plan with complete dimensions noted.
PART B. OWNERSHIP INFORMATION: To be completed by ALL applicants in accordance with the status of business stated above in Part A. This information must be provided for each owner/officer/director/partner as well as shareholders with stock interests equal or exceeding 5% and for any manager or agent will be conducting the business. If there are shareholders who own less than 5% indicate the aggregate total ownership in the space provided. |
Manager/Agent Conducting Business:
Name (Last, First, MI) | Home Address | City | state | Zip Code |
Social Security # | DOB | Title/Position | Phone # | % Owned |
United States Citizen: Yes (Place of Birth OR Place of Naturalization): ___________________________ No (Provide documentation identifying legal status in this country.) | ||||
Owners/Officers/Directors/Partners/Shareholders:
Name (Last, First, MI) | Home Address | City | state | Zip Code |
Social Security # | DOB | Title/Position | Phone # | % Owned |
United States Citizen: Yes (Place of Birth OR Place of Naturalization): ___________________________ No (Provide documentation identifying legal status in this country.) | ||||
Name (Last, First, MI) | Home Address | City | state | Zip Code |
Social Security # | DOB | Title/Position | Phone # | % Owned |
United States Citizen: Yes (Place of Birth OR Place of Naturalization): ___________________________ No (Provide documentation identifying legal status in this country.) | ||||
Name (Last, First, MI) | Home Address | City | state | Zip Code |
Social Security # | DOB | Title/Position | Phone # | % Owned |
United States Citizen: Yes (Place of Birth OR Place of Naturalization): ___________________________ No (Provide documentation identifying legal status in this country.) | ||||
Name (Last, First, MI) | Home Address | City | state | Zip Code |
Social Security # | DOB | Title/Position | Phone # | % Owned |
United States Citizen: Yes (Place of Birth OR Place of Naturalization): ___________________________ No (Provide documentation identifying legal status in this country.) | ||||
**Clubs/Associations must also submit a list of its members and addresses.
Part C. SOLE PROPRIETORSHIP INFORMATION: |
Name: ___________________________________________________________ Date of Birth: ______________________
First Middle Last
United States Citizen: Yes (Place of Birth OR Naturalization) ________________________________________________
No (if No, provide documentation identifying legal status in this country.)
Home Address: ______________________________________________________________________________________
Phone #: ____________________________________ E-mail: ________________________________________________
Social Security #___________________________________
Provide current and former employment history for the past 10 years:
Employer | Address | Phone |
Immediate Supervisor | Title/Position | From/To |
Employer | Address | Phone |
Immediate Supervisor | Title/Position | From/To |
Employer | Address | Phone |
Immediate Supervisor | Title/Position | From/To |
Part D. LIQUOR LICENSE HISTORY: TO BE COMPLETED BY ALL APPLICANTS AND OTHER PERSONS LISTED IN PART B. |
Indicate whether this is your first application for a liquor license: ____Yes _____No
If this is not your first application, identify each licensing authority (state, county, municipality) from which a license has been sought and the disposition of each application. If you have ever had a license denied, or if you have ever withdrawn an application, please provide a written statement setting forth the reasons and circumstances.
State/Country/Municipality | Granted/Denied/Withdrawn | Issuance Date, if any | Expiration Date, if any |
**Provide you Federal Tax Stamp Document Control Number showing that your business has been approved to sell alcoholic beverages by the Federal Bureau of Alcohol, Tobacco, and Firearm.
_________________________________________________________
Part E. ELIGIBILITY QUESTIONS: TO BE COMPLETED BY ALL APPLICANTS AND OTHER PERSON LISTED IN PART B. IF ANY QUESTION IS NOT ANSWERED, THE APPLICANT WILL BE REJECTED. |
YES NO
1.____ ____ Has any Applicant been delinquent in the payment of any Illinois Business Tax (Sales, Withholding, etc.)?
2.____ ____ Has any Applicant ever applied for and been denied a liquor license?
3.____ ____ Has any Applicant ever had any previous liquor license revoked?
4.____ ____ Has any Applicant ever been convicted of a felony?
5.____ ____ Does any Applicant possess a current federal wagering stamp issued by any Government Office?
6.____ ____ Has any Applicant ever been convicted of a gambling offense as defined and enumerated in the Illinois Liquor Control Act, 235 ILCS 56-2(16)?
7.____ ____ Are you, or another person with an interest in the business, a public official or law enforcement official with the jurisdiction of the Village of Brighton?
8.____ ____ Except for merchandise credit in the ordinary course of business, has any Applicant received or borrowed money, credit, or anything of value directly or indirectly from any other licensee, supplier, manufacturer, importer, distributor, or representative thereof, of alcoholic products?
If the answer to any of the above questions was ‘YES’, a written detailed explanation must be provided below:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
For each Owner, Manager, and/or Agent listed on this application, state whether he/she would be qualified to obtain a state and local liquor license. If your answer is NO, provide a complete explanation.
YES NO Name: ________________________________________________________________________
YES NO Name: ________________________________________________________________________
YES NO Name: ________________________________________________________________________
YES NO Name: ________________________________________________________________________
YES NO Name: ________________________________________________________________________
YES NO Name: ________________________________________________________________________
Part F. CERTIFICATION: APPLICATION MUST BE SIGNED BY AN OWNER, OFFICER, PARTNER OR AUTHORIZED AGENT OF THE BUSINESS. THE SIGNATURE MUST BE ORIGINAL-NO RUBBER STAMPS. |
I, the undersigned Applicant or Authorized Agents thereof, swear, affirm and certify that the matters stated in this application are true and correct and are made upon my personal knowledge and information for the express purpose of obtaining a liquor license from the Village of Brighton. Further, I swear, affirm and certify that the Applicant is qualified and eligible to obtain the license applied for and understands and agrees not to violate any of the laws of the United States, the State of Illinois or the Village of Brighton.
It is understood and agreed that the Village of Brighton will be notified within 30 days of any changes in the information stated herein.
_______________________________________ ____________________________ ________________
Print Name of Sole Proprietor/Authorized Agent Title/Position Date
_______________________________________
Signature of Sole Proprietor/Authorized Agent
_______________________________________ ____________________________ ________________
Print Name of Authorized Agent Title/Position Date
_______________________________________
Signature of Authorized Agent
Subscribed and sworn before me
This ____ day of ___________, 20___
NOTARY PUBLIC