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Home My Public Portal About040_Friends of Tybee Theater event CITY OF TYBEE ISLAND ALCOHOL LICENSE APPLICATION 4 , Application is hereby made for a license to do business within the Gty of Tybee Island as a dealer in alcoholic beverages as indicated below: 1 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 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 2,000 or if a corporation, Sunday Sales of Alcoholic Beverages 150 partnership or other Wholesale Beer 765 legal entity is the Wholesale Liquor 1,500 I owner, a substantial Wholesale Wine 150 and major stockholder Distiller, Brewer, or Manufacturer of Alcoholic Beverages 300 or the applicant may be Special Event - Public or Private Property - Beer, Wine (no current license) per event (4) the manager of the Special Event - Public or Private Property - Beer, Wine (no current license) 3 days 100 business charged with Special Event - Public or Private Property - Beer, Wine (holding current license) per event 10 the regular operation of Special Event - Business Property - Beer, Wine, Liquor (no current license) per event 50 said business on the Special Event - Business Property - Beer, Wine, Liquor (no current license) 3 days 100 premises for which the 1 Special Event - Business Property - Beer, Wine, Liquor (holding current license) per event I 10 license is issued. Business Name Location i ,:2, Mailing Address 0 .-e, x LAr,:, (:__1:1 Phone g i a - Sg,3 - 3- 4- ;-)_ -1-- ! Email I 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 GO-DONI Fr p, - 7 - 4 , E - ' ') Home Addresses City, Ste, Zip si=3. ) ',. 1 e tk.) 6 . "1 - ' - 9/6 et 1St- tl A b ea Social Security # OFF'iLr-g, 26w - ni. PEf isiiii 4,141. . I ?)43 i 1 is business incorporated? N 2 " State of incorporation ‘--- Date Incorporated ,.. Names of landlord of the business location f Mill S Address :- HAn iv LES Ki"::.: Phone What other business is conducted at this location? f.)::),A.: E Has application been made for required Ste and Federal Licenses? i....:1 , --i Has applicant, 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 violaton? Ni 0 O ever served time in prison or other con institution? r.j. c... 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 k ., LL.,--N If business is an eating establishment, are SUNDAY sales of alcoholic beverages contemplated? 1 i v". 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, KNOVVI N Yf i A:...OLUTELY, AND THE SAME IS AND ARE HEREBY SWORN TO ME TO BE TRUE UNDER PENALTY OF LAW. / 1/ I ," I ., :. / CV q Applicant Signat0re ' Date / Approval Signature Date i '.5.44-- t City Manager Swo5FrIo and subscribed before me this / , day of 4 e A° c2.) i 0 Zoning Police i ti-e-e.-- (-.. , C.ity Council 1 i Notary Public . SONNiE J, Hlettis Witty Pubilc, Chatham County, GA My Commlitsion Expires November V, 2011 CITY OF TYBEE ISLAND ALCOHOL LICENSE APPLICATION 4 , Application is hereby made for a license to do business within the Gty of Tybee Island as a dealer in alcoholic beverages as indicated below: 1 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 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 2,000 or if a corporation, Sunday Sales of Alcoholic Beverages 150 partnership or other Wholesale Beer 765 legal entity is the Wholesale Liquor 1,500 I owner, a substantial Wholesale Wine 150 and major stockholder Distiller, Brewer, or Manufacturer of Alcoholic Beverages 300 or the applicant may be Special Event - Public or Private Property - Beer, Wine (no current license) per event (4) the manager of the Special Event - Public or Private Property - Beer, Wine (no current license) 3 days 100 business charged with Special Event - Public or Private Property - Beer, Wine (holding current license) per event 10 the regular operation of Special Event - Business Property - Beer, Wine, Liquor (no current license) per event 50 said business on the Special Event - Business Property - Beer, Wine, Liquor (no current license) 3 days 100 premises for which the 1 Special Event - Business Property - Beer, Wine, Liquor (holding current license) per event I 10 license is issued. Business Name Location i ,:2, Mailing Address 0 .-e, x LAr,:, (:__1:1 Phone g i a - Sg,3 - 3- 4- ;-)_ -1-- ! Email I 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 GO-DONI Fr p, - 7 - 4 , E - ' ') Home Addresses City, Ste, Zip si=3. ) ',. 1 e tk.) 6 . "1 - ' - 9/6 et 1St- tl A b ea Social Security # OFF'iLr-g, 26w - ni. PEf isiiii 4,141. . I ?)43 i 1 is business incorporated? N 2 " State of incorporation ‘--- Date Incorporated ,.. Names of landlord of the business location f Mill S Address :- HAn iv LES Ki"::.: Phone What other business is conducted at this location? f.)::),A.: E Has application been made for required Ste and Federal Licenses? i....:1 , --i Has applicant, 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 violaton? Ni 0 O ever served time in prison or other con institution? r.j. c... 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 k ., LL.,--N If business is an eating establishment, are SUNDAY sales of alcoholic beverages contemplated? 1 i v". 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, KNOVVI N Yf i A:...OLUTELY, AND THE SAME IS AND ARE HEREBY SWORN TO ME TO BE TRUE UNDER PENALTY OF LAW. / 1/ I ," I ., :. / CV q Applicant Signat0re ' Date / Approval Signature Date i '.5.44-- t City Manager Swo5FrIo and subscribed before me this / , day of 4 e A° c2.) i 0 Zoning Police i ti-e-e.-- (-.. , C.ity Council 1 i Notary Public . SONNiE J, Hlettis Witty Pubilc, Chatham County, GA My Commlitsion Expires November V, 2011 Affidavit Verifying Status i for City Public Benefit Application 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 -36-1, I am stating the following with respect to my application of a City of Tybee Island: • Business License or Occupational Tax Certificate, 3 Alcohol License, (circle all that apply) • Taxi Permit. • Contract • Other public benefit for (printed name of natural person applying on behalf of individual, business, corporation, partnership, or other private entity). P 1) V 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 :eider 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 knowingly and willfully makes a false. fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of Code Section 16 -10 -20 of the Official Code of Georgia. i n f ti Si of pplicant ff Date BONNIE J. ?BIERS Notary Public, Chatham County, GA `:-/ f ; ` . CA' . f N, ? ; 7 `l / , A My CommIsslon Expires November 27, 241 Printed Name Alien Re6stration Number for Non- citizens SUBSCRIBED AND SW re, RN : FO' ME ON THIS THE J D A Y O F J '' w t t . 20 / Notary Public % ., : 4--e"- My Commission Expires: �� .c--- Note: O_C.G_A_ § 5D- 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. Oualied aliens that do not have an alien registration number may supply another identifying number below: