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Home My Public Portal About090_010_Mardi Gras MAYOR CITY MANAGER Jason Buelterman ,: Diane Schleicher CITY COUNCIL - i CITY CLERK Wanda Doyle,Mayor Pro Tern ( 4 f Janet LeViner Barry Brown Rob Callahan CITY ATTORNEY Bill Garbett Monty Parks Edward M.Hughes Monty f 4, Paul Wolff ci +o � "-Iti 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: January 16, 2014 Item: Alcohol License Request-Special Event-Beer. Wine— T bee Seabar Inc. - Tybee Island Mardi Gras Explanation: Tybee Island Mardi Gras Dates of event: March 1, 2014 Budget Line Item Number(if applicable): Paper Work: X Attached* Audio/Video Presentation** * Electronic submissions are requested but not required. Please email to ileviner��,citvoftvbee.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/Email: 912 472-50721 shaver( cityofivbee.org Comments: Date given to Clerk of Council January 16, 2014 P.O. Box 2749—403 Butler Avenue, Tybee Island,Georgia 31328-2749 (866) 786-4573—FAX (866) 786-5737 www.cityoftybee.org CITY OF TYBEE ISLAND ALCOHOL LICENSE APPLICATION Application is hereby made for a license to do business within the City of Tybee Island as a dealer in alcoholic _. 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 Retail liquor—Sale by Package Only,Consumption on Premises Prohibited 850 States,Chatham a County,resident of Retail Liquor—Sale by Drink for Consumption on Premises Only 1,250 Chatham County, and owner of the business Retail Liquor—Sale by Package&Drink both in One Building under One Ownership 2 000 or if a corporation, Sunda Sales—Sale • Drink for Consumption on Premises Oni 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 the manager of the Special Event—Public or Private Property-Beer,Wine(no current license)per event 50 ry/ 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 r t� {i"a - fip. Inc Location )1(si •3 T fit` 4 Mailing Address ? 0, x IC1110 � et-ISIC C f " i3 r e Phone(9l ) �K p 1 Email � t iti bSe i ` F6T . ( am 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# ��I � tiM� CaF r �r Ti p kS � rtlInail 0 11)9(1c Ik� If special event,date(s)of event I I i 1 I LI Name of event: 1' ! ".15 III� t I i L Is business incorporated? ''q.5 State of Incorporation (( cx Date In.. au,-5 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? 1 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 0 o ever served time in prison or other correctional institution? N t, n 1 o ever had an alcohol beverage license suspended or revoked at any time in any location? 1�►0 (if answer is yes,give details) N Y If this application is for RENEWAL of an existing license,enter License Number of existing license N 11 If business is an eating establishment,are SUNDAY sales of alcoholic beverages contemplated? NO 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 •:• = , .01).re THE SAME IS AND ARE HE BY S ORN TO ME TO BE TRUE UNDER PENALTY OF LAW. Applicant Signatur ► Date /2 ii‘f°(' n Approval _ Signature _ Date 'r lily Manager Sworn t a u ribed before n e■4 .' �1, da , ,1 0/ Zoning_ ', x . 9 Police U ` /� j City Counal N P Notary rC SHARON S. HAVER Notary Public,Chatham County,GA My 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 rr 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. FULL NAME(PN NT) SEX / RACE / DATE OF BIRTH 1 A Ca .l l n .Dr-- ADDRESS L CURITY NUMBER ,vin 1 I 1T CITY,STATE,ZIP IG I•E , The ACKNOWLEDGEMENT is required for all LIQUOR BY THE DRINK alcohol livens app ications. J fj_ ,l 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 A Denied 1 r - � Chief of Police 111111 7 Date V