Application for a license under this chapter shall be made to the Alcoholic Beverage Control Administrator, in writing, signed by the applicant if an individual, or by a duly authorized agent thereof if a club or corporation, verified by oath or affidavit, and shall contain the following statements and information:
(A) The name, age and address of the applicant in the case of an individual; in the case of a co-partnership, the persons entitled to share in the profits thereof; in the case of a corporation, the names and addresses of the officers, directors and any stockholder who owns 5% or more of the stock of such corporation;
(B) The location and description of the premises or place of business which is to be operated under the license;
(C) A statement that the applicant has never been convicted of a felony and is not disqualified to receive a license by reason of any matter or thing contained in this chapter, laws of the state or the ordinances of the city; and
(D) Whether a previous license by any state or subdivision thereof, or by the federal government, has been revoked and the reasons therefor.
(1997 Code, § 112.11)