§ 111.99 PENALTY.

Any person violating the provisions of this chapter shall, upon conviction, be subject to a fine not to exceed $500 or imprisonment in the county jail not to exceed 90 days, or both, for each day the violations shall continue and shall be guilty of a misdemeanor.

(Ord. 34, passed 8-18-2011)

Township of Somerset

12715 E. Chicago Road

Somerset Center, Michigan 49282

APPLICATION FOR ADULT ENTERTAINMENT BUSINESS LICENSE

Please print in ink or type the following information for each section below. The fee for processing this application is $1,500 and must be submitted with this form.

I. APPLICANT(S) NAME(S), MAILING ADDRESS, AND MISCELLANEOUS INFORMATION:

A. List applicant(s) name(s) and mailing address for proposed adult entertainment business:

________________________________________________________________________

B. For each individual applicant, state the following:

1. List any aliases used by applicant(s):_______________________________________

__________________________________________________________________

2. Applicant(s) date and place of birth:_______________________________________

__________________________________________________________________

3. Applicant(s) height and weight:___________________________________________

4. Applicant(s) hair and eye color:___________________________________________

5. Applicant(s) home address and telephone number:_____________________________

___________________________________________________________________

6. Applicant(s) Social Security number:_______________________________________

___________________________________________________________________

7. List the issuing state and number of applicant(s) driver’s license (attach a copy of the
applicant(s) driver’s license): _____________________________________________

___________________________________________________________________

C. If applicant(s) are a general or limited partnership, state and provide the following:

1. Copy of the partnership agreement and registration of the partnership with the state.

2. The complete name and the names of all partners, including general and limited partners:

__________________________________________________________________

3. State whether the partnership is a general or limited partnership: __________________

4. Partnership federal identification number: ___________________________________

D. If the applicant(s) are a corporation, state or provide the following:

1. A copy of the articles of incorporation as approved by the state.

2. Corporate federal identification number:____________________________________

3. The complete corporate name:___________________________________________

__________________________________________________________________

4. The date and place of incorporation:______________________________________

__________________________________________________________________

5. The names and capacity of all corporate officers:_____________________________

__________________________________________________________________

6. The names and capacity of all corporate directors:____________________________

__________________________________________________________________

7. The names and capacity of all principal shareholders (principal shareholder is any individual

or entity owning 20% or more of the corporations shares): _____________________

_

8. Name of the registered corporate agent:____________________________________

___________________________________________________________________

9. Address of registered officer:_____________________________________________

___________________________________________________________________

10. Attach a certificate of good standing from the Michigan DELEG evidencing that the corporation is in good standing.

II. USE OF FICTITIOUS NAME.

If the applicant(s) intends to operate the business under a name other than the corporate or partnership name listed above,

state the fictitious name. A copy of the registration of the fictitious name must be attached to this application at the time it is submitted.

List fictitious name(s):______________________________________________________________

_______________________________________________________________________________

III. APPLICANT.

For the purpose of this license form, “applicant” shall be defined to include:

A. Any individual;

B. Any partner in a partnership (general or limited);

C. Any officer, shareholder, or director in a corporation; and

D. Any agent associated with applicant who shall be considered part of the business so licensed.

IV. PROOF OF AGE.

Proof of age must be provided for processing of application. All applicants listed above must be at least 18 years of age.

All applicants must list age at time of application for business license and sign next to listed age in the space provided below.

All persons who have a 20% interest in the adult entertainment business must sign this application as an applicant.

Full Name (Printed) Age at Time of Application Signature

1. ___________________________________________________________________________

2. ___________________________________________________________________________

3. ___________________________________________________________________________

4. ___________________________________________________________________________

5. ___________________________________________________________________________

V. CRIMINAL HISTORY.

Specify whether any of the applicants(s), as defined herein, or any person presently residing with the applicant(s) has/have

been convicted of any of the following crimes:

A. Prostitution;

B. Promotion of prostitution;

C. Dissemination of obscenity;

D. Sale, distribution, or display of harmful material to a minor;

E. Sexual performance by a child;

F. Possession or distribution of child pornography;

G. Public lewdness;

H. Indecent exposure;

I. Indecency with a child;

J. Engaging in organized criminal activity;

K. Sexual assault;

L. Molestation of a child;

M. Gambling; and/or

N. Distribution, possession, or manufacture of a controlled substance.

Yes________ No________

If yes, state the following:

A. Name of offender:_________________________________________________________

B. Name of the crime:________________________________________________________

C. Date crime occurred:_______________________________________________________

D. Jurisdiction of crime:_______________________________________________________

E. Criminal sentence imposed:__________________________________________________

VII. PRIOR APPLICATIONS FOR AN ADULT ENTERTAINMENT LICENSE.

Specify whether any of the applicant(s), as defined herein, or persons presently residing with the applicant(s)

ever applied for an adult entertainment license before this or in any other jurisdiction:

Yes________ No________

If the answer to the preceding question is yes, list all jurisdictions where applications were submitted and

the date such application was submitted (list most recent first):

Jurisdiction_____________________________________________ Date______________

If any of the applications for adult entertainment licenses above were denied, suspended, or revoked, list

the name and location of the adult businesses for which the license was denied, suspended, or revoked.

Explain in concise form the reason such denial, suspension, or revocation. Attach a copy of all pertinent

documentation regarding the denial, suspension, and/or revocation of adult business license.

____________________________________________________________________________

Has the applicant(s), as defined herein, or a person presently residing with the applicant previously been a

partner, officer, director, or shareholder of a corporation or a partner in a partnership that was denied a

license to operate as an adult entertainment business or had a license suspended or revoked?

If yes, state the name of the partnership or corporation which was denied a license or had its license suspended

or revoked. State the location of the business and the jurisdiction which denied, suspended, or revoked said

license and the date said license was denied, revoked, or suspended.

____________________________________________________________________________

VII. OTHER ADULT BUSINESS LICENSE.

Does any of the applicant(s), as defined herein, or persons presently residing with the applicant(s) hold

an adult entertainment business license from this township or any other jurisdiction? If yes, specify the following:

A. Name of business:_________________________________________________________

B. Address of business:________________________________________________________

C. Affiliation with business:____________________________________________________

D. Jurisdiction where license was issued:_________________________________________

E. Date license was issued:_____________________________________________________

VIII. NATURE OF ADULT ENTERTAINMENT BUSINESS.

A. Describe the type of adult entertainment which will operate at the applicant’s premises (i.e. arcade,

bookstore, novelty store, video store, cabaret, theater, motion picture theater, live entertainment establishment, etc.).

______________________________________________________________________________

B. Attach a detailed description of the nature of the entertainment that is to be provided at the adult

entertainment business. All activities and business operations that applicant(s) intend to conduct on the specified

location must be described fully and accurately.

IX. LOCATION OF PROPOSED ADULT ENTERTAINMENT BUSINESS.

A. Attach a legal description of the property where the adult entertainment business will be conducted.

B. List the street address where the adult entertainment business will be conducted:

_________________________________________________________________________

C. List the telephone number of the proposed adult business: ______________________________

__________________________________________________________________________

D. Attach a sketch or diagram (drawn to scale), showing a configuration of the adult entertainment business premises.

NOTE: The sketch or diagram does not have to be prepared by a professional architect but it must be drawn to scale with

the scale clearly designated. The sketch or diagram should include a statement of the total floor space occupied by the business.

X. MISCELLANEOUS DOCUMENTS WHICH MUST BE ATTACHED TO THIS APPLICATION.

A. Color photograph of all applicant(s), as defined herein, which clearly shows the applicant(s) face.

B. A copy of all applicant(s), as defined herein, fingerprints.

NOTE: Applicant(s) are responsible for the cost of this photograph and fingerprints.

ALL INFORMATION ON THIS FORM MUST BE SUPPLIED BEFORE THE TOWNSHIP WILL PROCESS THIS APPLICATION FOR AN ADULT ENTERTAINMENT BUSINESS LICENSE. THE TOWNSHIP MUST PROCESS THIS APPLICATION WITHIN 30 DAYS OF SUBMISSION OF THIS APPLICATION. PLEASE REFER TO CHAPTER 111 OF THE TOWNSHIP OF SOMERSET CODE OF ORDINANCES, WHICH GOVERNS THESE BUSINESSES IN THE TOWNSHIP OF SOMERSET, BEFORE COMPLETING THIS FORM.

I hereby verify that the information contained in the foregoing application for an adult entertainment business license is true and correct to the best of my knowledge, information and belief.

_________________________________________________ Date:__________________