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Home My Public Portal About090_020_Tybee Pirate Fest 2013 MAYOR t. CITY MANAGER Jason Buelterman 4t's ,d44 Diane Schleicher CITY COUNCIL , CLERK OF COUNCIL Wanda Doyle, Mayor Pro Tern Janet LeViner Barry Brown Jan Foxy CITY ATTORNEY Bill Garbett Edward M. Hughes Tom Groover y.�°" Paul Wolff 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: September 26, 2013 Item: Alcohol License Request-Special Event-Beer and Wine Explanation: Tybee Pirate Fest Dates of Event: October 10-13, 2013 Budget Line Item Number(if applicable): Paper Work: X Attached` Audio/Video Presentation** * Electronic submissions are requested but not required. Please email to j levi n e r( c itvo ftv b ee.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 Shaver Phone/Email: 472-5072 /sshaver(ccityoftybee.org Comments: Date given to Clerk of Council September 18, 2013 .0. Box 2749—403 Butler Avenue,Tybee Island,Georgia 31328-2749 (866)786-4573—FAX(866) 786-5832 www.cityoftybee.org CITY OF TYBEE ISLAND? ; ALCOHOL LICENSE APPLICATION .1 Application is hereby made for a license to do business within the City of Tybee Island as a dealer in alcoholic "'s,.,.-„,"' beverages as indicated below: LICENSE CLASSIFICATION FEE CHECK Notice: The applicant Retail Beer/Wine—Package Sales Only,Consumption on Premises Prohibited $ 350 for a license shall be a Retail Beer/Wine—Sale by Drink for Consumption on Premises Only 575 citizen of the United i Retail Liquor—Sale by Package Only,Consumption on Premises Prohibited 850 States, a resident of Chatham County, and 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—Safe by Drink for Consumption on Premises Only 150 partnership or other Sunday Sales—Package Sales Only 50 legal entity is the Wholesale Beer 765 , owner, a substantial Wholesale Liquor 1,500 and major stockholder I 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 104 (< 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. S ecial Event—Business Property—Beer,Wine, Liquor(holding current license)per event 10 Business Name 'rS I3€E 5F i-I MC - location 1 4 Tit 1T.+ ee I ®i1f"/2 F'JV 0-r _ Mailing Address . O.• fi,_y ,clic) # N6c 7 , i 0t G4 , 3 t Q�j Phone C�t)) '.'i 1 I,- D a‘ L" Email T'1!j E E Q 1 4 T LT SSG Act . (.Cm Names and Home Addrpcces 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# �jti'YlLr'f(k w1 cun at case,t no,ior i►bec lS1 + rra If special event,date(s)of event Oc-V• I 0— 1 3 ()I P-2:49_,416-_44-6-s �°, Is business incorporated? CC. State of Incorporation G Date Incorporated c E P T Gk V t .3 Names of landlord of the business location—(_ f 1 0-c T lime c Address Phone _ What other business is conducted at this location? A.)OJ c Has application been made for required State and Federal Licenses? k, i 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? NI.t.s o ever served time in prison or other correctional institution? N\r' a ever had an alcohol beverage license suspended or revoked at any time in any location? KC', (if answer is yes,give details) If this application is for RENEWAL of an existing license,enter License Number of existing license No If business is an eating establishment,are SUNDAY sales of alcoholic beverages contemplated? N 144 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 Sign. r-'S IL! __" ►! 1.~ Date . I f 1 Approval Signature Date _ City Manager y Zoning Sw• n to a sue, ,.ed befo r day• Ii /_/:_, '. ,►I�/ Al Police ;milt a 1 / 1 My Council Notary Pub!i r SHARON S.SHAVER Notary Peilic,Chatham County,GA gmty Commission Expires Dec. 5, 2015 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, REGARDyINGG�AN ALCOHOL BEVERAGE LICENSE APPLICATION, FULL NAME(PRI ) SEX / RACE / DATE OF BIRTH 9 caw ADDRESS r r-� SOCIAL SECURITY NUMBER Cm', STATE,ZIP SIG RE DATE The ACKNOWLEDGEMENT is required for all LIQUOR BY THE DRINK alcohol license applications. ACKNOWLEDGEM ENT 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 amount of three percent of the charge to the public for the beverage. SIGNATURE 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 I, , do hereby make this affidavit to be part of my application for an alcohol beverage license in the City of Tybee Island to sell distilled spirits, malt beverages and/or wine for the consumption on the premises in my eating establishment on Sunday. Said establishment is located at Tybee Island, Georgia. I am the of the establishment known as 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. SIGNATURE DATE Approved Denied Chief of Police ,,f 9 7 ► 3 Date IUD RMA 67 J -V enl rsIc i°cr