HomeMy Public PortalAboutDoc_2010129 aj sLICENSE CLASSIFICATION
FEE
CHECK
Retail Beer /Wine Package Sales Only, Consumption on Premises Prohibited
350
Phone Email f��� cCl/lia
Retail Beer /Wine Sale by Drink for Consumption on Premises Only
575
Retail Liquor Sale by Package Only, Consumption on Premises Prohibited
850
Home Addresses
Retail Liquor Sale by Drink for Consumption on Premises Only
1,250
Retail Liquor Sale by Package Drink both in One Building under One Ownership
2,000
150
v
Sunday Sales of Alcoholic Beverages
Wholesale Beer
765
bed 6W101. GA •—a
Wholesale Liquor
1,500
Wholesale Wine
150
Distiller, Brewer, or Manufacturer of Alcoholic Beverages
300
Special Event Public or Private Property Beer, Wine (no current license) per event
50
Special Event Public or Private Property Beer, Wine (no current license) 3 days
100
Special Event Public or Private Property Beer, Wine (holding current license) per event
10
Special Event Business Property Beer, Wine, Liquor (no current license) per event
50
Special Event Business Property Beer, Wine, Liquor (no current license) 3 days
100
Special Event Business Property Beer, Wine, Liquor (holding current license) per event
10
Business Name /t i ti
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Location li�
Mailing Address
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Phone Email f��� cCl/lia
Names and Home Addresses of Owners, Partners or Corporate Officers with Ten Percent (10 Interest in Business
Names (attach additional pages if necessary) J
Date of Birth
Home Addresses
City, St
Social Security
CkiAlryouirrt
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bed 6W101. GA •—a
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:
Is business incorporated? �pp��
Names of landlord of the busi en s (�hh,, s location l �rt'I4�tjress
What other business is conducted at this lot (brr'
State of Incorporation
V 1 J i
Has application been made for required State and Federal Licenses?
Has applicant, any person connected with, or any person having an intere in this business:
o ever been convicted of any violation of law other than for a traffic violation? Y v °D
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 l/'V
If business is an eating establishment, are SUNDAY sales of alcoholic beverages contemplated?
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.
A• e W
HEATi ER BROq E �i VIVIIRy y 4
2M fr tj
Sworn to and'subsdribcd bef�r t}ii$, of A
EFFINGHAM COUNTY
Notary Public STATE OF GEORGIA
My Commission Expires October 30, 2012
Applicant Signatur
Phone
{GI 3o 5
Approval
Signature
Notice: The applicant
for a license shall be a
citizen of the United
States, a resident of
Chatham County, and
owner of the business
or if a corporation,
partnership or other
legal entity is the
owner, a substantial
and major stockholder
or the applicant may be
the manager of the
business charged with
the regular operation of
said business on the
premises for which the
license is issued.
Date Incorporated 211 l'200®
If yes, submit additional affidavit.
Date
City Manager
Zoning
Police
City Council