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Daily License Application-Authorization-Non Transferable ABC-221 - California

Daily License Application-Authorization-Non Transferable Form. This is a California form and can be used in Department Of Alcoholic Beverage Control Statewide .
 Fillable pdf Last Modified 11/22/2010
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Department of Alcoholic Beverage Control State of California ARNOLD SCHWARZENEGGER, Governor DAILY LICENSE APPLICATION/AUTHORIZATION - Non Transferable Instructions: Complete all items. Submit to local ABC District Office with required fee (Cashier's Check or Money Order) payable to ABC. Once license is issued, fee cannot be refunded. For a listing of ABC District Offices please visit http://www.abc.ca.gov/distmap.html Pursuant to the authority granted by the organization named below, the undersigned hereby applies for the license(s) described below. LICENSE NUMBER GEO CODE RECEIPT NUMBER FEE $ 1. ORGANIZATION'S NAME CONDITIONS REQUIRED DIAGRAM REQUIRED Yes 2. LICENSE TYPE (Check appropriate license type AND organization type) Daily General ($25.00) (Includes beer, wine and distilled spirits) Political Party/Affiliate Supporting Candidate for Public Office or Ballot Measure Organization Formed for Specific Charitable or Civic Purpose Other: No Yes No a. Fraternal Organization in Existence Over Five Years with Regular Membership Religious Organization Vessel per Section 24045.10 B&P ($50.00) NUMBER OF DISPENSING POINTS b. Special Daily Beer ($25.00) Charitable Civic Fraternal Religious Social Cultural Special Daily Beer & Wine ($50.00) Political Other: Amateur Sports Organization (Different privileges depending on statute) Special Daily Wine ($25.00) NUMBER OF DISPENSING POINTS c. Special Temporary License ($100.00) Television Station per Section 24045.2 or 24045.9 B&P Nonprofit Corporation per Sections 24045.4 and 24045.6 B&P Other Special Temporary Licenses, per Section License number 3. EVENT TYPE Person conducting Estate Wine Sale per Section 24045.8 B&P Women's Educational and Charitable Organization per Section 24045.3 B&P Amount $ Dance Concert Wedding Birthday Lunch Mixer From Picnic Carnival Barbeque Dinner Dance Social Gathering Other: To 8. EVENT IS OPEN TO THE PUBLIC Dinner Sports Event 4. TOTAL # OF DAYS Festival 5. ESTIMATED ATTENDANCE 6. HOURS OF ALCOHOLIC BEVERAGE SALES, SERVICE AND/OR CONSUMPTION 7. EVENT DATE(S) Yes 9. EVENT LOCATION (Give facility name, if any, street number and name, and city) No 10. LOCATION IS WITHIN THE CITY LIMITS 11. TYPE OF ENTERTAINMENT 12. SECURITY GUARDS Yes No Yes No If yes, how many? 14. REPRESENTATIVE'S TELEPHONE NUMBER 13. AUTHORIZED REPRESENTATIVE'S NAME 15. REPRESENTATIVE'S ADDRESS 16. ORGANIZATION'S MAILING ADDRESS (If different from #15 above) 17. AUTHORIZED REPRESENTATIVE'S SIGNATURE 18. DATE SIGNED PROPERTY OWNER APPROVAL BY (Name), REQUIRED PHONE NUMBER PROPERTY OWNER SIGNATURE DATE SIGNED LAW ENFORCEMENT APPROVAL BY (Name), IF APPLICABLE PHONE NUMBER LAW ENFORCEMENT SIGNATURE DATE SIGNED DISTRICT OFFICE APPROVAL BY (Name) ABC EMPLOYEE SIGNATURE ISSUANCE DATE The above-named organization is hereby licensed, pursuant to the California Business and Professions Code Division 9 and California Code of Regulations, to engage in the temporary sale of alcoholic beverages for consumption at the above named location for the period authorized above. This license does not include off-sale ("to-go") privileges. This license may be revoked summarily by the Department if, in the opinion of the Department and/or the local law enforcement agency, it is necessary to protect the safety, welfare, health, peace and morals of the people of the State. ABC-221 (rev. 11/10) American LegalNet, Inc. www.FormsWorkFlow.com
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