Idaho > Statewide > State Police > Alcohol Beverage Control
Beer And Wine License Application - Idaho
| Beer And Wine License Application Form. This is a Idaho form and can be used in Alcohol Beverage Control State Police Statewide . |
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Idaho State Police Alcohol Beverage Control Bureau 700 S. Stratford Dr. Ste 115 Meridian, ID 83642 Ph. (208) 884-7060 Fax (208) 884-7096 www.isp.idaho.gov/abc Premises File Number: _______________ License Number: ___________________ Opening Date: _____________________ See Instruction Sheet Beer and Wine License Application 1. Application Type New Transfer [ Applicant Location] Floor Plan License Types (See #2)] Change Current Application [ `Doing Business As' Name (See #3) 2. License Type and Fees See Instruction Sheet for Fees Beer $50.00 Wine by the bottle $100 Wine by the Glass $100 Keg Beer to Go $20.00 On-Premises Consumption $0.00 Restaurant $0.00 Total Fees: _______________ 3. Applicant Information A. Applicant Name: ________________________________________________________________________________ (Individual, Corporation, LLC, Partnership or other business entity) `Doing Business As' Name: ___________________________________ Business Phone No.: ______________________ Business Physical Address: ____________________________________________________________________________ City: _______________________________ County: ____________________________ Zip: ______________________ Mailing Address: ____________________________________________________________________________________ (Include City, State, Zip) Alternative Phone No.: ______________________________ E-Mail Address: __________________________________ Former Business Name (Transfers Only): ________________________________________________________________ B. Applicant's Idaho State Tax Commission Seller's Permit Number: _____________________________________ C. Applicant's Financial Information Business Bank Name and Address (Branch): ______________________________________________________________ Persons Authorized to Sign on Account: ___________________________________ Title: _______________________ 4. List sole proprietor(s) or all partners, corporate officers, directors, ten primary stockholders, LLC/LLP members/partners of the applicant. Attach a separate sheet of paper following the format below. Name: ______________________________________ Address: __________________________________________ Title: _____________________ SSN: ______________________________ DoB: ____________________________ Idaho Resident: (Y/N) _________________________ If `YES' length of residency: __________________________ A. Sole Proprietor(s): Married: (Y/N) ____ [If `yes' provide Spouse's information by following the format below (fingerprints are required) or provide a Separate Property Agreement] Name: ________________________________________ Address: ________________________________________ Title: ________________________ SSN: _______________________ DoB: ________________________________ Idaho Resident: (Y/N) _____________________ If `YES' length of residency: ____________________________ B. Has Applicant or anyone listed on #4 ever had an alcohol license suspended, denied or revoked? No Yes (Attach Explanation) C. Has Applicant or anyone listed on #4 ever been convicted of a felony or an alcohol-related misdemeanor? No Yes (Attach Explanation) 5. Has Applicant or anyone listed on #4 ever held any interest in any other business licensed for the sale of alcoholic beverages? No Yes [Attach Explanation - Include Premises Number] 6. Does anyone have any financial interest in the Applicant's business not previously listed on #4, including silent partners, financial loans, etc.? No Yes [Attach Explanation] EH 10.02-02 Beer & Wine Application Page 1 of 2 Rev. 7/2011 American LegalNet, Inc. www.FormsWorkFlow.com 7. List the owner of the building where the premises is located: ______________________________________ (Include a copy of the building lease to the Applicant OR a warranty Deed in the Applicant's name) 8. Premises Diagram/Floor Plan No architectural blue prints On paper no larger than 8 ½ " x 11" Attach a sketch showing the entire area proposed to be licensed to sell, serve, dispense or store alcoholic beverages, including patios, decks, etc. Diagram must show all entrances, exits, offices, restrooms, kitchen facilities (if applicable), bar(s), bar backs, liquor cabinets, tables, refrigeration units, partitions, etc. and where license will be prominently displayed. 9. Affirmation: The applicant hereby swears or affirms under oath that the applicant is the bona fide owner of the business which is applying for this license and will be engaged in the sale or dispensing of beer and/or wine by the bottle and/or glass. The applicant hereby affirms that the applicant is eligible and has none of the disqualifications for a license as provided by Title 23, Chapter 9, 10, 11, 13 and 14, Idaho Code or any amendments thereto. An application for and acceptance of a license by a retailer shall constitute consent to, and be authority for, entry by the Director or his authorized agents, upon any premises related to the licensee's business, or wherein are or should be kept, any of the licensee's books, records, ledgers, supplies or other property related to said business, and to make the inventory, check and investigations aforesaid with relation to said licensee or any other licensee. It shall also constitute consent given to the Director or his authorized agents to view, copy or investigate any documents, including state and federal income and sales tax documents, related to the business or person(s) associated with the business of selling alcohol as granted herein, as per Idaho Code sections 23-907, 23-1006 and 23-1314. Applicant hereby acknowledges that falsifying this document or submitting any false documents for record can result in a felony conviction under Idaho Code sections 23-905 or 18-3203. Each sole proprietor, partner, corporate officer, director, shareholder, LLC/LLP member/partner listed herein or attached hereto understands that all fingerprints submitted to ABC will be processed through the Federal Bureau of Investigation (FBI). Any determination of a person's licensure based on the criminal record received from the FBI can be challenged or corrected pursuant to Title 42, U.S.C. §14616, Article IV(c); Title 28, C.F.R. §§ 16.34 and 50.12(b) and ABC's policy. 10. Signature Attestation: I/we, the applicant of this license, have read all of the above and declare under penalty of perjury that the information that I/we have provided is true and correct to the best of my/our knowledge. _________________________________________ __________________
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