The URL can be used to link to this page

Home My Public Portal About050_FoTT_1112Hwy80_20110417 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 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 citizen of the United one — Sale by Drink for Consumption on Premises Only 575 ! States, a resident of Retail Liquor — Sale by Package Only, Consumption on Premises Prohibited 850 1 Chatham County, and Retail Liquor — Sale by Drink for Consumption on Premises Only 1,250 I I owner of the business Retail Liquor — Sale by Package & Drink both in One Building under One Ownership 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 l or the applicant may be Special Event — Public or Private Property - Beer, Wine (no current license) per event I 50 i the manager of the Special Event — Public or Private Property - Beer, Wine (no current license) 3 days I 100 V business charged with Special Event — Public or Private Property - Beer, Wine (holding current license) per event 1 10 the regular operation of Special Event — Business Property — Beer, Wine, Liquor (no current license) per event I 50 said business on the Special Event — Business Property — Beer, Wine, Liquor (no current license) 3 days I 100 premises for which the Special Event — Business Property — 13 Beer, Wine, Liquor (holding current license) per event I 10 license is issued. Business Name v i - 1 r irk It < I r T Y 1c_ - {`1w 4 t['6 tke LZ. rP r Location t t 1 vk VS , , - 1 W `-i O f A I t !' t'_ k_ Z ito ri 4 __ c . �1 Mailing Address Phone t p . (") x , ~� ` . 1 q ✓� 3 � 3 _ 7 I Email tlih Hit_Q eLti . r P 1,1440 6 0 ii4 • 1 Names and Home Addresses of Owners, Partners or Corporate Officers with Ten Percent (10 %) Intere in Business 1 1 I Names (attach additional pages if necessary) I Date of Birth I Home Addresses I City, State, Zip I Social Security # 5 0 dk; S F Ci 'yoidt., k I ; i c.. j i7lnl I I 1 111 � � 1 I I I I Is business incorporated? Lit ."-> State of Incorporation 6:; Date Incorporated // - 0 Names of landlord of the business location IJ ievl. Address Phone What other business is conducted at this location? 1 li4 Has application been made for required State and Federal Licenses? NI to 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? 14- 0 o ever served time in prison or other correctional institution? is-) 0 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 KJ 0 If business is an eating establishment, are SUNDAY sales of alcoholic beverages contemplated? LIPS 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, KNOWINGLY SOLUTELY, AND THE SAME IS AND ARE HEREBY SWORN TO ME TO BE TRUE UNDER PENALTY OF LAW. Applicant Signature,,,., Date ^�� —'� L____---/ Approval rgna t rife Date , 1 ��,,/� 1 City Manager 1 /�f'� - (,1 — ,Jil..�■ V ."—/fi Sworn to and scribed before me , : - ..._ ' 2 day of 7)142 d0 // Zoning i O I Police r►� 1 � A IS- L- /i City Council /� 1 Notary Public // U BONNIE J. HERS Notary Com Publicisslon Exp, Chm 1 OA My m ires hat November aCounty 27, 2011 F` 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, • Alcohol License e -_ - -- (circle all that apply) • Taxi Permit, • Contract • Other public benefit for (printed name of natural person applying on behalf of individual, bu • ess, corporation, partnership, or other private entity). 1) 1 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 under 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 th. • - - son who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an a . vit shall b- • it of a violation of Code Section 16 -10 -20 of the Official Code of Georgia. Signatur- .f Applicant Date . ;A / J 3NES Printed Name * Alien Registration Number for Non - citizens SUBSCR ED AND SW a c, BEFO ME ON THIS THE DAY OF , 2 0 / 1 BONNIE J. HIERS Notary Public, Chatham County, GA Notary Public 7/ 1'` My Commission Expires November 27� 2011 My Commission Expires: { L Y,-Ut/Z °R ! » Note: O. C. G.A. ¢ 50- 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. Qualified aliens that do not have an alien registration number may supply another identifying number below: 1 ---- 9--Rq The CONSENT FOR is required for ALL alcohol Incense 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 3US 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 LICENSE APPLICATION. 5 JONES >- tv 21110f- FULL NAME (PRINT) SEX / RACE / DATE OF BIRTH C I bnc t P ADDRESS • ■ a• • NUMBER 50Av C 314 J r lob )S -1 / CITY, STATE, ZIP = ' ATURE / DATE The ACKNOWLEDGEMENT is required for all LIQUOR BY THE DRINK alcohol license applications. ACKNOWLEDGEMENT I declare knowl - .: and u • -rstanding of Municipal Code Section 58 -80: There is levied an excise tax on the sale of distilled spi e d k in the amount of three percent of the charge to the public for the beverage. t( 1/ SI --�' 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 . furnish -•i to the City up in 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 (50 %) of the total annual gross food and beverage sales are derived from the sale of prepared meals or f > =.i. SIGNATURE DATE ?i Approved / Denied 1 Chief of Police ;L41)1)-011 Date 1 I