HomeMy Public PortalAboutDoc_2010129 huc a poosBusiness Name ,2jA ,01494,3
Location h2 f zoe e ey__ 6 31 n`
Mailing Address
3/2
P73/ -73./.4e-e. X
74
5 r -L7 Email
Phone d- 1� 5 0 /YX4r.... f
t
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
/tom 7 YYIWS
850
927 letzeitk v /lyc
.641 a 3/0',
1 250
n ,S tbr�Vr9
2,000
/I C. we hi s/
Fit? 67
150
Wholesale Beer
765
Wholesale Liquor
LICENSE CLASSIFICATION
FEE
CHECK
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.
Retail Beer /Wine Package Sales Only, Consumption on Premises Prohibited
350
Retail Beer /Wine Sale by Drink for Consumption on Premises Only
575
t/
.Retail Liquor Sale by. Package Only, Consumption on Premises Prohibited
850
r/
Retail Uquor 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
Sunday Sales of Alcoholic Beverages
150
Wholesale Beer
765
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, Uquor (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
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? y S State of Incorporation )Claim 4r4 Date Incorporated xo
Names of landlord of the business location ke x Address p0• 6c')( Phone
What other business is conducted at this location? c1C0/17edg 4 79 7 y,i jfS ter ju,a
Has application been made for required State and Federal Licenses? S
Has applicant, any person 'connected with, or any person having an interest in this business: CO
o ever been convicted of any violation of law other than for a traffic violation? /VI 141/4re... 47,er/
o ever served time in prison or other correctional institution? nie
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? Ye S If yes, submit additional affidavit.
ALL OF THE FOREGOING INFORMATION I 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.
Applicant Signature
S orn to d subscribed
Notary P blic
JANICE G. ELLIOTT
Notary Public, Chatham County, GA
My Commission Expires July 5, 2011
4l
Gily/(69
A royal
tar sir mum
Police
Ci Council
Si. nature Date
i�-