HomeMy Public PortalAboutDoc_2010129 jaydeep-shell foodCity Manager
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Location
Names (attach additional pages if necessary)
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RANTA a, PATEL
Is business incorporated? es
Names of landlord of the business location
What other business is conducted at this location?
Date of Birth
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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 dealer in alcoholic
beverages as indicated below:
LICENSE CLASSIFICATION
Retail Beer /Wine Package Sales Only, Consumption on Premises Prohibited
Retail Beer /Wine Sale by Drink for Consumption on Premises Only
Retail Liquor Sale by Package Only, Consumption on Premises Prohibited
Retail Liquor Sale by Drink for Consumption on Premises Only
Retail Liquor Sale by Package Drink both in One Building under One Ownership
Sunday Sales of Alcoholic Beverages
Wholesale Beer
Wholesale Liquor
Wholesale Wine
FEE
350
575
850
1,250
2,000
150
765
1,500
150
300
50
100
10
50
CHECK
100
Distiller, Brewer, or Manufacturer of Alcoholic Beverages
Special Event Public or Private Property Beer, Wine (no current license) per event
Special Event Public or Private Property Beer, Wine (no current license) 3 days
Special Event Public or Private Property Beer, Wine (holding current license) per event
Special Event Business Property Beer, Wine, Liquor (no current iicense) per event
Special Event Business Property Beer, Wine, Liquor (no current license) 3 days
Special Event Business Properly Beer, Wine, Liquor (holding current license) per event
1 n
Name Business Nam
Y LLB �3A NHL Poop MART
ISIS euTLE AvE TYBEE AcNth CAA St
Mailing Address p. (4S
Phone q y BE Z�LAN1�,— 313
(G 12) 786 I Email N/A
Names and Home Addresses of Owners, Partners or Corporate Officers with Ten Percent (10 Interest in Business
Home Addresses
Has application been made for required State and Federal Licenses? `>i GS
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? i�1 0
o ever served time in prison or other correctional institution? N (°I
o ever had an alcohol beverage license suspended or revoked at any time in any location? i" 0
(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?
City, State, Zip
aoG EAGLEt sT LAN e:TyRE-ems A ri 7
111 CRRss cREE Dt�rE PnoLER -3t3zz
State of Incorporation Date Incorporated (c c R
l` i/ /s. Address �VVA, Phone
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.
I III/I1 i
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1
Applicant Sig
Approval
Not ary Publ WHIM!
My Commission Expires March 5, 2013
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.
Social Security
If yes, submit additional affidavit.