Arizona > Statewide > Liquor Licenses And Control
Request For Approval For Continuation Of Restaurant License - Arizona
| Request For Approval For Continuation Of Restaurant License Form. This is a Arizona form and can be used in Liquor Licenses And Control Statewide . |
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ARIZONA DEPARTMENT OF LIQUOR LICENSES AND CONTROL 800 W Washington, 5th Floor Phoenix, AZ 85007-2934 (602) 542-5141 (Grill License) 400 W Congress, #521 Tucson, AZ 85701-1352 (520) 628 - 6595 Request for Approval for Continuation of Restaurant License Pursuant to A.R.S. §4-213(C)(E) One-time $30,000 Fee Due upon Issuance License No: ____________________Agent's/Licensee's Name:______________________________________________ Last First Middle Individual Partnership LLC Corporation JTWROS N/A Corporation/Partnership/LLC:_____________________________________ A.C.C. File #:_________________________ Exactly as it appears on Articles of Incorporation or Articles of Organization Business Name: ___________________________________________________________________________________ Exactly as it appears on License Business Address: _________________________________________________________________________________ Street Address- (Do not use P.O. Box Number) ________________________________________________________________________________________________________________________ City County State Zip Business Phone: (_______) ________ -______________ Mailing Address: ___________________________________________________________________________________ ________________________________________________________________________________________________ City State Zip For purposes of this application, "percentage verification" is defined as a 6-month financial review for the purposes of verifying actual food sales percentage. Important! Please Note: If you have not been audited by the Department of Liquor Licenses and Control within the past 12 months, a Percentage Verification will be conducted by the Department. Certain records will be required for this process. These records must be original records (copies of sales tax reports are acceptable). All records listed below must be complete and submitted to the Department or you will not be eligible for consideration for a Continuation of Restaurant License. The records must be presented to the Department of Liquor Licenses and Control at 800 W. Washington, 5th Floor, Phoenix, Arizona 85007-2934 within 10 days of the filing of this form. If the Percentage Verification proves less than 30% food sales, a complete audit may be conducted by the Department's auditing staff which may result in the potential revocation of your liquor license. Items required for verification period 1. Menu and drink price list used 2. All food and liquor invoices and receipts 3. X and Z tapes accompanied by detailed daily sales journals. If you are using a POS system, provide detailed daily sales journals only. The daily sales journals must separate food, liquor and miscellaneous sales. 4. Copies of any coupons or specials 5. Records of all complimentary items served separating food and liquor 6. Bank Statements 7. Financial Statements (Balance Sheet and Profit and Loss Reports for each month) 8. Transaction Privilege Tax Reports (Sales Tax) 9. Guest Checks This Section for Official Use Only Director Approve Disapprove Date American LegalNet, Inc. www.FormsWorkflow.com Diagram of Premises: Complete a detailed diagram of your current floor plan. Restaurants must depict kitchen equipment and dining facilities. (Blueprints will not be accepted. Diagram must be on this form.) 1. Check all boxes that apply to your licensed premises: Entrance/Exits Drive-thru windows Service windows Liquor Storage Areas Patio Enclosures 2. The licensed premises consists of _________________ total square feet. 3. Kitchen occupies ______ percent of total floor space. 4. ___________ percent of the public interior area floor space consisting of pool tables, dart or arcade games, barstools cocktail tables and similar types of seating and dance floors. 5. Aggregate area of all dance floors is ________ percent of the total floor space of the public area of the premises. 6. Please identify the area where spirituous liquor is dispensed, sold, served, consumed or stored. DO NOT INCLUDE PARKING LOTS, LIVING QUARTERS, ETC. YOU MUST NOTIFY DEPARTMENT OF LIQUOR WHEN MAKING ANY CHANGES OF BOUNDARIES, ENTRANCES, EXITS, DRIVE-THRUS OR SERVICE WINDOWS MADE AFTER SUBMISSION OF THIS DIAGRAM. 9/20/06 2 American LegalNet, Inc. www.FormsWorkflow.com I __________________________________, the agent/licensee for_________________________________, Printed Name of Agent/Licensee Name of Business am requesting consideration for a Continuation of Restaurant License pursuant to A.R.S. §4-213 (as provided on reverse side), and I declare that: 1) The above establishment is maintaining a food sales percentage of at least 30% but less than 37%; 2) I understand that should I be approved for the Continuation of a Restaurant License, that the license is not transferable and can only be maintained under the approved business name, entity and location. 3) I understand that if the establishment were approved and subsequently there were changes in the operation of the restaurant in any way that materially or detrimentally affected the representations made on this application, the Department may initiate an audit or terminate the license without audit. 4) If approved for a Continuation of a Restaurant License, I understand there will be a one-time $30,000 fee payable at the time of issuance in addition to the statutory mandated renewal fees. 5) I have read the application form for Continuation of a Restaurant License and certify that all of the contents and statements are true, correct and complete. X_____________________________________________________________ _________________________ Signature Date State of______________ County of ______________________ The foregoing instrument was acknowledged before me this ____________ day of ___________________,_____________ Date Month Year My commission expires on: _______________________________________ Signature of NOTARY PUBLIC ___________________ Date 9/20/06 3 American LegalNet, Inc. www.FormsWorkflow.com CONTINUATION OF A RESTAURANT LICENSE 4-213(C) If the audit or consent agreement, that may be offered at the discretion of the director and that is signed by the licensee and the director, reveals that the licensee did not meet the definition of a restaurant as prescribed in Sections 4-205.02 and the percentage of food sales determined by the audit or consent agreement was: 1. 2. Less than thirty percent, the Department shall revoke the license At least thirty percent, but less than thirty-seven pe
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