HomeMy Public PortalAbout090_010_Tybee Island Bait and Tackle MAYOR CITY MANAGER
Jason Buelterman
♦ Diane Schleicher
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CITY COUNCIL CLERK OF COUNCIL
Wanda Doyle,Mayor Pro Tern Janet LeViner
Barry Brown »'
Bill Garbett CITY ATTORNEY
Paul Wolff Edward M. Hughes
Torn Groover
ocitiO
Jan Fox 'o
CITY OF TYBEE ISLAND
City Council Agenda Item Request
Agenda Item Requests and supporting documentation must be submitted to the Clerk of Council by
4:00PM on the Thursday prior to the next scheduled Council meeting. If this form is received after the
deadline, the item will be listed on the next scheduled agenda.
Council Meeting Date for Request: August 8, 2013
Item: Alcohol License Request-Retail Beer/Wine-Package Sales Only, Consumption on Premises Prohibited
Sunday Sales (new owner-replacing Tybee's Bait and Tackle at Lazaretto)
Explanation: — Tybee Island Bait and Tackle
Business License Number: 02627
Budget Line Item Number(if applicable): -
Paper Work: X Attached*
Audio/Video Presentation**
Electronic submissions are requested but not required. Please email to
llev iner(a:cityofty bee.o rg.
** Audio/video presentations must be submitted to the IT department at City Hall
by 4:00PM on the Thursday prior to the scheduled meeting.
Submitted by: Sharon S. Shaver
Phone/Email: 912 472-50721 sshaver(a�ci yoftirbee.org
Comments:
Date given to Clerk of Council August 1, 2013
* * *
P.O. Box 2749—403 Butler Avenue,Tybee Island,Georgia 31328-2749 *Certified*
(866)786-4573—FAX(866) 786-5737 City.of
www.cityoftybee.orgithi ,y
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RECEIVED
' 7-2 Z 3
CITY OF TYBEE ISLAND
ALCOHOL LICENSE APPLICATION ,y `
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Application is hereby made for a license to do business within the City of Tybee Island as a dealer in alcoholic
as indicated below:
LICENSE CLASSIFICATION FEE CHECK Notice: The applicant-Retail Beer/Wine-Package Sales Only,Consumption on Premises Prohibited $ 350 V! for a license shall be a
IRetail BeerLWine-Sale by Drink for Consumption on Premises Only 575 citizen of the United
, Retail Liquor-Sale by Package Only,Consumption on Premises Prohibited 650 States, a resident of
t - Chatham County, and
I Retail Liquor-Sale by Drink for Consumption on Premises Only 1,250 _ owner of the business
Retail Liquor-Sale by Package&Drink both in One Building under One Ownership 2,000 or if a corporation,
Sunday Sales-Sale by Drink for Consumption on Premises Only 150 / _ partnership or other
Sunday Sales-Package Sales Only 50 V legal entity is the
Wholesale Beer 765 owner, a substantial
Wholesale Liquor 1,500 _ and major stockholder
Wholesale Wine - 150 or the applicant may be
Distiller,Brewer,or Manufacturer of Alcoholic Beverages 300 the manager of the
Special Event-Public or Private Property-Beer,Wine(no current license)per event 50 business charged with
Special Event-Public or Private Property-Beer,Wine(no current license)3 days 100 the regular operation of
_Special Event-Public or Private Property-Beer,Wine(holding current license)per event 10 said business on the
Special Event-Business Property-Beer,Wine,Liquor(no current license)per event 50 premises for which the
Special Event-Business Property-Beer,Wine,Liquor(no current license)3 days 100 license is issued.
-
Special Event-Business Property-Beer,Wine,Liquor(holding current license)per event 10
Business Name ,• 1 }]C53 {q(
Location M r
Mailing Address -iL
Phone G‘1 } .e.,;, }` jeimI sizes r, Email ,. -
rr,A 4 .
Names and Home Addresses of Owners,Partners or Corporate Officers with Ten Percent(10%)Interest in Business
Names(attach additional pages if necessary) Date of Birth Home Addresses City,State,Zip Social Security#
• r i4-7t...) qr.'4_ l--- .
If special event,date(s)of event
Is business incorporated? i . State of Incorporation Date Incorporated
Names of landlord of the business location x:\,1 \ L `i\S Address Phone (\IA ' 444 1 -'-)1
What other business is conducted at this location? e 'tic•; :.° c-a -4 :c,.s
Has application been made for required State and Federal Licenses? ' k-C
Has applicant,any person connected with,or any person having an interest in this business:
o ever been convicted of any violation of law other than for a traffic violation? ,' '"t
o ever served time in prison or other correctional institution? .-%`-',
o ever had an alcohol beverage license suspended or revoked at any time in any location? ,",e n.
(if answer is yes,give details)
If this application is for RENEWAL of an existing license,enter License Number of existing license
If business is an eating establishment,are SUNDAY sales of alcoholic beverages contemplated? lc'', If yes,submit additional affidavit.
ALL OF THE FOREGOING INFORMATION IS HEREBY GIVEN AND ALL OF THE FOREGOING STATEMENTS ARE HEREBY MADE ON OATH WILLFULLY,
KNOWINGLY,AND ABSOLUTELY,AND THE SAME IS AND ARE HEREBY SWORN TO ME TO BE TRUE UNDER PENALTY OF LAW.
Applicant Signature-- _., Gil,/ $e i 73 Approval Signature Date
r City Manager
a to and subsc ;efo} me this �' day of e. _-A,r Zoning
City/l�04 City Gauncil
N ry Public JERRI 1A. BRYANT
Notary Public,Chatham County GA
My Commission Expires May 22,2016
The CONSENT FORM is required for ALL alcohol license applications.
CONSENT FORM
I HEREBY AUTHORIZE THE TYBEE ISLAND POLICE DEPARTMENT TO REQUEST ANY CRIMINAL BACKGROUND HISTORY RECORD
INFORMATION PERTAINING TO ME WHICH MAY BE IN THE FILES OF ANY STATE OR LOCAL CRIMINAL JUSTICE AGENCY. BE IT FURTHER
UNDERSTOOD THAT THE PURPOSE OF OBTAINING THIS INFORMATION IS TO SATISFY THE REQUIREMENTS SET FORTH BY THE MAYOR
AND COUNCIL OF THE CITY OF TYBEE ISLAND,REGARDING AN ALCOHOL BEVERAGE LICENSE APPLICATION.
sc4-4, &ZAN S-6,1„,..)6A it ciso,LeAsicIA •, -
FULL NAME(PRINT) I SEX / RACE / DATE OF BIRTP
ZtO D.Z (X1 'C (q t, L ' �_
ADDRESS SOCIAL SECURITY NUMBER
CITY,STATE,ZIP SIGNATURE / DATE
The ACKNOWLEDGEMENT is required for all LIQUOR BY THE DRINK alcohol license applications.
ACKNOWLEDGEMENT
I declare knowledge and understanding of Municipal Code Section 58-80: There is levied an excise tax on the sale
of distilled spirits by the drink in the mount of three percent of the charge to the public for the beverage.
1 — la - IS
SIGN URE DATE
The AFFIDAVIT is required if SUNDAY SALES of alcohol for consumption on premises are contemplated. Food
and beverage sales records prepared by a CPA are required to be furnished to the City upon request.
STATE OF GEORGIA
COUNTY OF CHATHAM
CITY OF TYBEE ISLAND
AFFIDAVIT
S
I, 6 C 4` yy -3tRdt-.11.f , do hereby make this affidavit to be part of my application for an
alcohol beverage license ifi the City of Tybee Island to sell distilled spirits, malt beverages and/or wine for the
consumption on the remises in my eating establishment on Sunday. Said establishment is located at
IA ;tr» si the_
premises
6 5 ,Tybee Island, Georgia.
I am the cpwt f of the establishment known as S .I s 14 L]oL-J 0 .T , .t
I hereby further state that at least fifty percent (50%) of the total annual gross food and beverage sales are
derived from the sale of prepared meals or food.
J —1- 1 — 1L '
SIGN TURE DATE Iy� `` c �1\
Approved / Denied Chief of Police a�
cj '1 Jf d, Date