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Managers License Renewal Form - District Of Columbia
| Managers License Renewal Form Form. This is a District Of Columbia form and can be used in Alcoholic Beverage Regulation Administration Statewide . |
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Government of the District of Columbia Alcoholic Beverage Regulation Administration For Official Use Only License Period: Initials: Date: MANAGER'S LICENSE RENEWAL FORM MANAGER'S INFORMATION Please indicate if any of the following have occurred since the last renewal period: 1. Please place an `X" in the applicable box below: Name Change 2. Manager's Application Number 4. Manager's Name Last 5. Home Address Number 6. Home Telephone Street 7. Business Telephone ( ) yes ( ) no City/State First Address Change 3. License Number Middle Zip code 8. Have you been convicted of a misdemeanor or felony since the last renewal? If yes, attach a copy of the court disposition. 9 Certification: I hereby certify under perjury that the information in this application and attachments are true and correct to the best of my knowledge and belief. I will also conform to all laws and regulations related to the alcohol and beverage license for which I have applied. ____________________________ Subscribed and sworn to before me ____________________________ Signature on this _____ day _____, 20___. Notary Public 10 Please answer the question: In what language do you need vital documents translated, if any? 11. Have you attached a copy of your alcohol awareness training certificate? ( ) yes ( ) no Have you attached your Clean Hands Certification? ( ) yes ( ) no My commission expires on _____________. INSTRUCTIONS FOR FILING A RENEWAL APPLICATION FOR A MANAGER'S LICENSE APPLICATION Your current manager's licenses will expire soon. You can renew now, please report to 941 North Capitol Street, NE, Room 2200, Washington DC 20002 between the hours of 8:30 a.m. 3:30 p.m., Monday through Friday. We strongly encourage you to renew during the off-peak hours of 8:30 a.m. 10:30 a.m. to avoid long lines. Under no circumstances will anyone be processed after 3:30 pm. The renewal fee is $260.00 for a 2 year period. Failure to renew timely could result in a late penalty of $50. Please read all questions carefully. Each question must be answered. All payments can be made in the form of a check or money order payable to the D.C. Treasurer, cash, or by credit card (except for American Express). 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Please place an "x" to indicate if there is a name or address change. Print your application number. Print your license number. Print your name (Last Name, First Name, Middle Initial). Print your home address. Print your home telephone number. Print your business telephone number. If you have checked yes, you must submit the court's disposition on the conviction. Certification/Affidavit: Please read, and have your signature notarized. Please answer the question: In what language do you need vital documents translated, if any? ATTACHMENTS REQUIRED: The applicant must submit a copy of his or her certificate showing completion of an alcohol awareness training program within the previous 2 years from a Board approved training provider with his or her manager's license renewal application. In addition, the Clean Hands Certification must be completed and the Office of Tax and Revenue (OTR) must verify. OTR's Customer Service Center is located, on the 1st Floor of 941 North Capitol Street, NE Washington DC 20002. SPECIAL NOTICE The District of Columbia will provide appropriate auxiliary services including sign language interpreters whenever necessary to effectuate communication with members of the public who are deaf, hard of hearing or who may have other disabilities affecting communication. Please contact the ADA coordinator at (202)4424423. American LegalNet, Inc. www.FormsWorkflow.com
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