VILLAGE OF EAU CLAIRE’S
APPLICATION FOR APPROVAL OF
MICHIGAN LIQUOR CONTROL COMMISSION LICENSE
I. APPLICATION INFORMATION
1. Name of applicant: ______________________________________________________
2. Current residential address of applicant: __________________________________
__________________________________
3. Current business address of applicant: __________________________________
__________________________________
4. Date of birth of applicant: ________________________
5. Social Security number of applicant: ________________
6. Is applicant a business entity (corporation, partnership, limited liability company)? If so, please identify the type of entity and provide the following information:
a. Name of each corporate shareholder, partner or member:
_______________________________________________________________
b. Address of each shareholder, partner or member: ________________________
_______________________________________________________________
c. Nature and extent of investment of each shareholder, partner or member:
_______________________________________________________________
d. Name and address of each officer, director and shareholder if the applicant is a corporation:
_______________________________________________________________
_______________________________________________________________
II. LOCATION INFORMATION
1. Address of proposed location: ____________________________________________
2. Description of the premises or place of business which is to be operated under the license:
_____________________________________________________________________
_____________________________________________________________________
3. Has the applicant, or any person associated with the applicant made application for a similar or other license on premises other than premises described in this application?
_____________________________________________________________________
If so, please state the date of each such application and please state the location of the premises for each such application: __________________________
_____________________________________________________________________
III. CRIMINAL HISTORY
1. Has the applicant ever been convicted of a felony? ____________________________
If so, please state the date of each conviction, court of each conviction, and crime related to each conviction: ______________________________________
____________________________________________________________________
2. Has any person affiliated with the applicant been convicted of a felony?___________
If so, please state the date of each conviction, court of each conviction, and the charge related to each conviction: _______________________________________
____________________________________________________________________
IV. AFFIRMATION
I hereby swear and affirm that applicant will not violate any of the laws of the State of Michigan, the United States of America or any ordinances of the Village of Eau Claire in the conduct of applicant’s business. I hereby swear and affirm that the information contained in this application is true and accurate.
Dated: __________________ ______________________________
Applicant signature
STATE OF MICHIGAN )
)ss:
COUNTY OF BERRIEN )
The foregoing instrument was acknowledged before me this _____ day of ________, 20___, by ___________________________.
____________________________________
_______________________ , Notary Public
_____________________ County, Michigan
My Commission Expires: ________________
ADDITIONAL INFORMATION DEEMED PART OF THIS APPLICATION:
Please be advised that in accordance with the Ordinances of the Village of Eau Claire, this Application must be accompanied by building and plat plans showing the entire structure and premises; and in particular the specific areas where the license is to be utilized. The plans shall demonstrate adequate off-street parking, lighting, refuse disposal facilities and, where appropriate, adequate plans for screening and noise control. The premises at which the license is to be located shall be inspected by the appropriate Village of Eau Claire Officials prior the public hearing. The premises shall comply with all Ordinances of the Village of Eau Claire.
(Ord. 2006-1A, passed 3-20-2006)