HomeMy Public PortalAbout090_010_2014 Agenda Request-Paint Georgia Pink MAYOR CITY MANAGER
Jason Buelterman Diane Schleicher
CITY COUNCIL \iiT7` CITY CLERK
Wanda Doyle,Mayor Pro Tern . -: 1 Janet LeViner
Barry Brown
Rob Callahan CITY ATTORNEY
Bill Garbett � Edward M. Hughes
Monty Parks i �'
Paul Wolff _!x'
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 14, 2014
Item.: Alcohol License Request-Special Event-Beer, Wine-
Huc-a-•oo's
Explanation: Paint Geor..is Pink for Breast Cancer!Event location: Memorial Park
Dates of event: September 20, 2014
Budget Line Item Number(if applicable):
Paper Work: X Attached*
Audio/Video Presentation**
* Electronic submissions are requested but not required. Please email to
j leviner(aacitvoftybee.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: 912 472-5072/sshaver@cityoftybee.org
Comments:
Date given to Clerk of Council July 31, 2014
P.O. Box 2749—403 Butler Avenue,Tybee Island, Georgia 31328-2749
(866) 786-4573—FAX (866) 786-5737
www.cityoftybee.org
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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 deafer in alcoholic
A�1 /�
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, a resident of
Chatham County, and
_ Retail Liquor—Safe 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 Safes—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 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—Been Wine,Liquor(no current license)per event 50 premises for which the
Special Event—Business Property—Beer Wine,Liquor(no current license)3 days lti license is issued.
_Special Event—Business Property—Beer,Wine,Liquor(holding current license)per event 10
Business Name "e— .•�00- -
Location /0.2 f4. /
Mailing Address
7 -7.s / /�
Phone !/.� ` . �i` I Email ic-L S ' - „ L'. (ate
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#
C.2/C / i®m1j , ry V ,Y4✓'. CO ?/ea.y
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If special event,date(s)of event ! ( Name of event: I i L° 1'1/ .
.
Is business incorporated? State of Incorporation Date Incorporated _
Names of landlord of the business location Address Phone
What other business is conducted at this location? / .e,7i 1(}Y f Ca Has application been made for required State and Federal Licenses? /k5
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?_ '
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?
(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? If yes,submit additional affidavit.
ALL OF THE FOREGOING INFORMATIe IS HEREBY GIVEN AND ALL OF THE FOREGOING STATEMENTS ARE HEREBY MADE ON OATH WILLFULLY,
KNOWINGLY,AND Ar. e • LY, + ►. E SAME IS AND ARE HEREBY SWORN TO ME TO BE TRUE UNDER PENALTY OF LAW.
Applicant Signature `' Date__7/411/0,,v__.
if st Approval Signature Date
/ City Manager
Sworn toan+-', ,•• .- ere, • ethis. day of 0101JY zoning
Polite
Niff •
' I��_.. r .� _ City Council
Notary Pub/RR*A. BRYANT
Notary Public,Chatham Coorti GA
My Commission Expires May 22=2018
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 CENSE APPLICATION.4-_-) A W
FULL NAME PRINT SEX RACE f DATIOF KITH
7 /aw' ? -r _ _ w.-
ADDRESS SOCIAL SECURITY NUMBER
1.V 01 ,,701e-/ ��l
`CLTY,STATE,ZIP I i -
RE / 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 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 (5001o) of the total annual gross food and beverage sales are
derived from the sale of prepared meals or food.
SIGNATURE DATE
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Approved Denied Chief of Police
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Date
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