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Home My Public Portal About090_010_Tybee Theater MAYOR , CITY MANAGER Jason Buelterman +�. 6 Diane Schleicher CLERK OF COUNCIL CITY COUNCIL Janet LeViner Wanda.Doyle,Mayor Pro Tern Barry Brown Jan i CITY ATTORNEY Bill Garbett .# Edward M.Hughes Tom Groover j„.. t" 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: October 24, 2013 Item: Alcohol License Request-Special Event-Beer and Wine Explanation: Friends of Tybee Theater Date of event: Saturday, April 12, 2014 Budget Line Item Number(if applicable): Paper Work: X Attached* Audio/Video Presentation** * Electronic submissions are requested but not required. Please email to ilevinerna cityoftybee.org. ** 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 f Email: 912 472-50721 sshaver @cityoftybee.org Comments: Date given to Clerk of Council October 15, 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 F ALCOHOL LICENSE APPLICATION t 4 : Application made for a license to do business within the City of Tybee Island as a dealer in alcoholic PP is hereby 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 citizen of the United Retail Beer/Wine—Sale by Drink for Consumption on Premises Only 575 States, a resident of Retail Liquor—Sale by Package Only,Consumption on Premises Prohibited 650 . 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—Sale 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 Wholesale Wine 150 - or the applicant may be Distiller,Brewer,or Manufacturer of Alcoholic Beverages 300 J 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 Spedal 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 rd' s OE Tc) Th Location -['kl, ee 15�. -{ v ,i 3o Me64tr,.. _Drivve -cti6e..2 IS cti,c) C-.aF 13.2}- Mailing Address e.O. X 1-3S LI' iri&ep is' cc 04t L 5" Phone 1 11 _ (2(a '3 f}} I Email t 1206 e.c___-( Names and Home Addresses of Owners,Partners or Corporate Officers with Ten Percent(10%)Interest in Business Names(attach additional pages if necessary) I Date of Birth' Home Addresses City,State,Zip Social Security# 11 rr If special event,date(s)of event 9 12,�'( Name of event: i ('�i t12. L _ i -p t_ i velf f) r Is business incorporated? � _ State of Incorporation 6.A Date Incorporated ,)�IY�P "`� m Names of landlord of the business location Address Phone What other business is conducted at this location? Has application been made for required State and Federal Licenses? v7�'� Has applicant,any person connected with,or any person having an interest in this business: c ever been convicted of any violation of law other than for a traffic violation? tJ`) - a ever served time in prison or other correctional institution? Ni s a ever had an alcohol beverage license suspended or revoked at any time in any location? IQ c. (if answer is yes,give details) A� If this application is for RENEWAL of an existing license,enter License Number of existing license 1_1 Pr If business is an eating establishment,are SUNDAY sales of alcoholic beverages contemplated? f V 0 If yes,submit additional affidavit. ALL OF THE FOREGOING INFORMATIO IS HEREBY GIVEN AND ALL OF THE FOREGOING STATEMENTS ARE HEREBY MADE ON OATH WILLFULLY, KNOWINGLY,AND ABSOLUTELY,A i H SAME IS AND ARE HER :Y SWORN TO ME TO BE TRUE UNDER PENALTY OF LAW. - .. Q Applicant Signature Ai: ■ �, e'4�i , Date Approval Signature Date M City Manager Sw, to.�1 I) - cribed b`.e�fore me s aNt day of IF_ __f_ I/3 Zoning r I f I I,1�Lr7� Police. _- A ''�,fa _ _i �1 1t r[ J� City Council Notes 'ublic SHARON S.SHAVER Notary Public,Chatham County,GA My Commission Expires Dec. b, 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 FORTT-i BY THE MAYOR AND COUNCIL OF CITY OF TYBEE ISLAND, ING AN ALCOHOL BEVERAGE LICENSE APPI Tf ATLON. 0 I _ - �, FULL NAME(PRINT) SEX r B RACE / DATE'OF tTH 7 .1 (;) AV ,,-4,1t,-DRF29 AD SOCIAL j� SOCIAL SECURITY NUM: STATE,MP / SIG -r d AP"RE' / ._e DATE er 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 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 Al Chief of Police l A Date w No + Ei Rf3.1 Pc P IS-10(Y 1a-11 -3 pp rIti Affidavit Verifying Status for City Public Benefit Application ,...,i,,,. By executing this affidavit under oath, as an applicant for a City of Tybee Island, Georgia, Business License or Occupation Tax Certificate,Alcohol License,Taxi Permit,Contract,or other public benefit as referenced in O.C.G.A.Section 50-364,I am stating the following with respect to my application of a City of Tybee Island: • Buses s Lie sense,or Occupational Tax Certificate, Alcohol License ' (circle all that apply) • Taxi Permit, • Contract • Other public benefit for (printed name of natural person applying on behalf of individual,business oration,partnership,or other private entity). 1) I am a United States citizen. OR 2) I am a legal permanent resident 18 years of age or older or I am an otherwise qualified alien or non-immigrant under the Federal Immigration and Nationality Act, 18 years of age or older and lawfully present in the United States.* In making the above representation under oath,I understand that any person who kn.wingly and willfully makes a false,fictitious,or fraudulent statement or representation in an affidavit shall be guilty of a violation .. Code Section 16-10-20 of the Official Code of Georgia. - 11/ s' LEd Si_+ ureo • •p- T,• Date' 7/0 Printed Name *Alien Registration Number for Non-citizens— COPY OF DOCUMENTATION REQUIRED SUBSC ND S •.Op : ORE ,'t ON THIS THE _ AY OF IL ,ol.41 I ,�f0 Notary Public , me, _ ; 4 SHARON S.SHAVER �•••- Notary Public,Chatham County,GA My Commission Expires: My Commission Expires Dec 5. 2015 Note: O.C.G.A. §50-36-1(e)(2) requires that aliens under the federal Immigration and Nationality Act, Title 8 U.S.C., as amended, provide their alien registration number. Because legal permanent residents are included in the federal definition of"alien", legal permanent residents must also provide their alien registration number. Qualified aliens that do not have an alien registration number may supply another identrfying number below: