HomeMy Public PortalAbout090_020_Taste of Tybee 2013 MAYOR 10, CITY MANAGER
Jason Buelterman Diane Schleicher
CITY COUNCIL + _{ CLERK OF COUNCIL
Wanda Doyle, Mayor Pro Tern Janet LeVfner
Bill Garrett
Paul Wolff CITY ATTORNEY
Barry Brown •. , th Edward M. Hughes
Tom Groover
Jan Fax CITY OF TYBEE ISLAND
City Council Agenda Item Request
Agenda Item Requests and supporting documentation must be submitted to the Clerk of Council by
4:00PM 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: July 11, 2013
Item: Alcohol License Request-Special Event-Beer and Wine- Taste of Tybee
Explanation: Savannah Area Chamber of Commerce
Date of event: September 12, 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(iccitvoftybee.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/Email: 912 472-50721 sshaver(11acityoftybee.org
Comments:
Date given to Clerk of Council July 1,2013.
* * *
P.O. Box 2749—403 Butler Avenue,Tybee Island,Georgia 31328-2749 **Certified*
City of ,
(866)786-4573—FAX (866)786-5737 Ethics y�
www.cityoftybee.org �a B L,�sk
CITY OF TYBEE ISLAND Iff
ALCOHOL LICENSE APPLICATION
Application is hereby made for a license to do business within the City of Tybee Island as a dealer in alcoholic °iii .,..->-`
beverages as indicated below:
LICENSE CLASSIFICATION FEE CHECK Notice: The applicantl
Retail Beer/Wine-Package Sales Only,Consumption on Premises Prohibited $ 350 for a license shall be a
Retail Beer/Wine-Sale by Drink for Consumption on Premises Only 575 citizen of the United
Retail Liquor-Sale by Package Only Consumption on Premises Prohibited 850 States, a Coresident of
_Retail Liquor-Sale by Drink for Consumption on Premises Only 1,250 Chatham Corun , and
owner of the ty business
Retail Liquor-Safe 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 , , and major stockholder
Wholesale Wine 150 or the applicant may be
Distiller,Brewer,or Manufacturer of Alcoholic Beverages 300 the manager of the
Special 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
Special Event-Business Property-Beer,Wine.Liquor(no current license)per event 50 premises for which the
Special Event-Business Property-Beer,Wine. Liquor(no current license)3 clays 100 license is issued.
Special Event-Business Property-Beer,Wine, Liquor(holding current license)per event 10
Business Name ,t P1{e1 ovvvvtAb/1/ Q - 09yv
Location ,O I Nui C L— cAtsfa Ur l iiL .2.J 140 I
Mailing Address
1,•b. p, ttv7Q) rrif _lnaAt,, f o2- • f Z8
Phone Ci 12-• tt±'
Email -66114./
Names and Home Addresses of Owners, Partners or Corporate Officers with Ten Percent(10%)Interest in Business
Names(attach additional pages if necessary) []ate of Birth Home Addresses City,State,Zip Social Security#
J t lip 1- d I ' 11 1i --S6 K !r A t,
. 1 640(4,
If special event,date(s)of event 1`12•!3 Name.,r event:r1sel'n 1. x I,,' t (c-'- L e e
Is business incorporated? 7 c State of Incorporation aE [Herr ora C'#1i" Ito`7
Names of landlord of the business location p_) , Address Phone-
What other business is conducted at this iocation?
Has application been made for required State and Federal Licenses? No - Vved (.4` T/bee_n 7pY J
Has applicant,any person connected with,or any person having an interest in this business: Fr elf
O ever been convicted of any violation of law other than for a traffic violation? 0
e ever served time in prison or other correctional institution? M_0 -
• ever had an alcohol beverage license suspended or revoked at any time in any location? h1 C)
(if answer is yes,give details)
If this application is for RENEWAL of an existing license,enter License Number of existing license IJ/�A - - -
If business is an eating establishment,are SUNDAY sales of alcoholic beverages contemplated? " 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,AND ABSOLUTELY,AND THE SAME IS AND ARE HEREBY SWORN TO ME TO BE TRIJC UNDER PENALTY OF LAW.
Applicant Signatul _ 11r.' ite ---L •j '' 1 5 dok 4 Approval _ Signature Date
/ City Manager
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— �. ► � — City CouIcii
Nola -
JENNY W. CENT
N y Public,Chatham Co.^tti�,GA
My Commission Expires Separritv 14,2014
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,REGARDING AN ALCOHOL BEVERAGE LICENSE APPLICATION.
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FULL NAME(PRINT) SEX I RACE / DATE OF BIRTH
61816 w -W ,rd ,ft
ADDRESS - ___ . . - -
SOCIAL SECURITY NUMBER
`" ' 3titIo ,_ _ _ _.... 4II •! '• 1.13
ITY,STATE,ZIP GNATURE 0 DAT°ai
The ACKNOWLEDGEMENT is required for all LIQUOR BY THE DRINK alcohol license applications,
ACKNOWLEDGEMENT
I declare knowledge and understanding of Municipal Code Section 59-80:There is levied an excise tax on the sale
of distilled spirits by the drink in the amount of three percent of the charge to the public for the beverage.
SIGNATURE 4 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 o • epa red meals or food.
1? .., 1 1 l ) CI)
SIGNATURE DATE
Approved Denied. Chief of A Da
lir
110 1546Y y
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