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Home My Public Portal About090_010_Tybee Gay Days May 4 2013 MAYOR CITY MANAGER Jason Buelterman +� Diane Schleicher CITY COUNCIL , CLERK OF COUNCIL Wanda Doyle,Mayor Pro Tern Janet LeViner Barry Brown , CITY ATTORNEY Jan Fox ddJ Edward M. Hughes Bill Garbett Torn Groover 4400km' Paul Wolff CITY OF TYBEE ISLAND City Council Agenda Item Request Agenda Item Requests and supporting documentation must be submitted to the Clerk of Council by 4:00P11 on the Thursday prior to the next scheduled Council meeting. If this form is received after the deadline,the item will be listed on the next scheduled agenda. Council Meeting Date for Request: April 25, 2013 Item: Alcohol License Rea uest-S•-cial Event-Beer Wine and Li•uor Explanation: Tybee Gay Days at the Tybee Wedding Chapel, 1114 Hwy 80 Savannah Pride, Inc. Date of Event: May 4, 2013 Budget Line Item Number(if applicable): Paper Work: X Attached* Audio/Video Presentation** * Electronic submissions are requested but not required. Please email to ileviner cityoftybee.org. ** Audio/video presentations must be submitted to the IT department at City Hall by 4:00PM on the Thursday prior to the scheduled meeting. Submitted by: Sharon S. Shaver Phone 1 Ernail:912 472-5072 sshaver @cityoftybee.org Comments: Date given to Clerk of Council April 11,2013 - .0. Box 2749—403 Butler Avenue,Tybee Island,Georgia 31328-2749 (866) 786-4573—FAX(866) 786-5832 www.cityoftybee.org CITY OF TYI3EE ISLAND ALCOHOL LICENSE APPLICATION Application is hereby made for a license to do business within the City or Tybee Island as a dealer in alcoholic beverages as indicated below: - LICENSE CLASSIFICATION FEE CHECK Notice: The applicant fora license shall be a Retail Beer/Wine-Package Sales Only Consumption on Premises Prohibited $ 350 citizen of the United Retail Beer/Wine-Sale by Drink for Consumption on Premises Only 575 States, a resident of _Retail L rrL-Sale by Package Only,Consumption on Premises Prohibited 850 Chatham 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_ or if a corporation, Sunday Sales-Sale by Drink for Consumption on Premises Only 150 partnership or other Sunday Sales-Package Sales Only 50 legal entity is the Wholesale Beer 765 owner, a substantial .... Wholesale Liquor _ 1,500 and major stockholder Wholesale Wine - 150 or the applicant may be Distiller, Brewer,or Manufacturer of Alcoholic Beverages 300 the manager of the Spero!Event-Public or Private Property-Beer,Wine(no current license)per event 50 business charged with Special Event-Public or Private Property-Beer,Wine(no current license)3 days 100 the regular operation of Special Event Public or Private Property-Beer, Wine(holding current license)per event 10 said business on the v_. ,,.s premises for which the 15.eeial Event-Business Prope -Beer.Wine Liquor no current license ser event 50 license is issued. Special Event-Business Property-Beer,Wine, Liquor(no current license)3 days 100 . Special Event-Business Prope -Beer,Wine, Usual- holding current license .er event 10 Business Name r!d w —l4 b: t I'"I.•C_ Location '- f A/ 7 L Mailing Address 0• 4 4 j 4D g SePibli? r . / / Phone 7 /Q - .23 /- if 3 7 ' Email Citrii d SdvpP dE • tea+-«. 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 Hone Addresses City,state,Zip Social Security# C4641 r�r ' ' i 2337 C. 9o1 .1 S 1i e4.394-, ' -r , v . f�'•7/ /Of�t I. e •-/io sJ. i/YAW . - - If special event,date(s)of event t! `iel e J Is business incorporated? % J. - State,of Incorporation /if Incorporated / � 11 1J ,,N Names of landlord of the business location _ /4 Address Phone What other business is conducted at this location? 11/0.41 C -Has application been made for required State and Federal Licenses? Pen-.44*"' Has applicant,any person connected with,or any person having an interest in this business: ever been convicted of any violation of law other than for a traffic violation? AA, ever served time in prison or other correctional institution?— 11/0 - 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 Al./1♦!" - If business is an eating establishment,are SUNDAY sales of alcoholic beverages contemplated? a If yes,submit additional affidavit. ALL OF THE FOREGOING INFORMATION I5 HEREBY GIVEN AND ALL OF THE FOREGOING STATEMENTS ARE HEREBY MADE ON OATH WILLFULLY, KNOWINGLY,AND AB 0 LY,AND THE !v1 IS AND ARE HEREBY SWORN TO ME TO BE TRUE UNDER PENALTY OF LAW. Date +' f 4'2 Applicant Signature �� Approval Signature Date City Manager 7 I 1 Sworn to and sub ' d before me this 9 Ai 4.. _day of_ r f ."1-4).L5 Zoning A Police - _ _ _ City Council iggraiel, -.1"11M17741, LATOYA BYRD Notary Public,Chatham County,GA My Commission Expires October 2$, 2013 The CONSENT FORM is required for ALL alcohol license 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 JUSTICE 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, EGARDING AN ALCOHOL BEVERAGE LICENSE APPLICATION. I AA c-A. �..- FULL NAME(PRINT SEX / RACE / DATE OF BIRTH / ;1 ADDRESS SOCIAL S . l LIMBER 5,•- anY1,4C‘- J9'341- 31cloc( 4.00" c-Ft I I lir 5_, CITY,STATE,ZIP GNATI)RE f DATE The ACKNOWLEDGEMENT is required for all LIQUOR BY THE DRINK alcohol license applications. ACKNOWLEDGEMENT I declare knowledge and u. anding of Municipal Code Section 58-80: There is levied an excise tax on the sale of distilled spin • . do amount of three percent of the cha ge to the public for the beverage. CI I , 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 be furnished to the City upon request. STATE OF GEORGIA COUNTY OF CHATHAM CITY OF TYBEE ISLAND AFFIDAVIT I, N7 r , 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 food, SIGNATURE DATE Approved Denied, Chief of Police Date I_ The CONSENT FORM is required for ALL alcohol license applications. CONSENT FORM I HERESY 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 JUSTICE AGENCY. BE IT FURTHER i UNDERSTOOD THAT THE PURPOSE OF OBTAINING THIS INFORMATION IS TO SATISFY THE REQUIREMENTS SET FORTH BY THE MAYOR AND COUNCIL OF THE Crr OF TYBEE ISLAND,REGARDING AN ALCOHOL BEVERAGE LICENSE APPLICATION. !`� iivio-eic 2 /4. / r art G.r FULL NAME(PRINT) SEX / RACE / DATE OF BIRTH ADDRESS SOCIAL SECURITY NUMB R L 'A'' . ( . )rY�, F1/11,...1r •oi 041A/j CITY,STATE,ZIP SIGNATURE / DATE The ACKNOWLEDGEMENT is required for all LIQUOR BY THE DRINK alcohol license applications. ACKNOWLEDGEMENT I declare knowledge and understanding of Municipal Code Section 58-80: There is levied an excise tax on the sale of distilled spirts by the drink in th amount of three percent of the charge too`the public for the beverage, `fr `� /() SIGNATURE 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 be furnished to the City upon 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 food. SIGNATURE DATE rs7 Approved Denied Chief of Police L _ - Date 4:4...0+DY;1/4I eY1 r' , ,