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Solicitors Application - District Of Columbia
| Solicitors Application 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 SOLICITOR'S APPLICATION OFFICIAL USE ONLY License Number: Fees Paid: $ Date Approved by Board / / Date Denied by Board / / From Initial: Initial: TO BE COMPLETED BY APPLICANT 1. Applicant's Name (Last, First, Middle Initial): 2. Date of Birth: 5. Residential Address 6. Are you eligible to work in the United States? Yes below: 7. a. 3. Place of Birth: City 4: Home Telephone Number: State Zip Code Date Accepted: To Issue Date: Accepted by: From To No If yes, please bring in qualifying documents and provide the information g. Expiration date: US Passport b. Naturalization papers c. Work permit d. e. Green card Visa f. Certificate number: 8. Have you ever: a. received or applied for any alcoholic beverage license in D.C. or any state or territory Yes No b. had any alcoholic beverage license suspended or revoked Yes No c. been convicted of a misdemeanor during the last five (5) years or a felony during the last ten (10) years (If yes, attach a copy of the court dispositon(s).) Yes No 9. Does any member of your immediate family now hold an ABC license or have any financial Yes No interest, directly or indirectly, in any ABC licensed establishment in the District of Columbia? 10. If you have answered yes to question 8 or 9, please submit a detailed explanation. 11. Certification I __________________________________________________________, hereby certify that, I have obtained and read Title 25 of the D.C. Official Code and Title 23 of the District of Columbia Municipal Regulations. I understand that I will be held responsible for complying with the laws and regulations contained therein. I, certify under penalty of perjury, that the statements in the foregoing are true and correct. __________________________________ Subscribed and sworn to before me Signature on this _____ day of___, 20___. 12. In what language do you need vital documents translated? ___________________________ My commission Notary Public expires on _____________ American LegalNet, Inc. www.FormsWorkflow.com Solicitor's Employment Certification 13. To be completed by a Sole Proprietor, the individual must sign, if Partnership, each partner must sign, if Corporation, the President or Vice President must sign, if LLC, the managing member. 14. Are you a licensed DC Wholesaler? Yes No If no, please list the state where you hold a license:________________________ 15. Employer's name (As shown on the ABC License): 16. Employer's Address: (As shown on the ABC License): 17. Trade name: 18. Business Telephone: 19. License Number: If you are a Sole Proprietor, the individual must sign, if Partnership, each partner must sign, if Corporation, the President or Vice President must sign, if LLC, the managing member must sign the below certification. 20. Certification: I hereby certify under penalty of perjury that I, (we), have employed the above referenced applicant, as an Alcoholic Beverage Control Solicitor. Printed name:______________________________ _________________________________________________________ Subscribed and sworn to before me Signature on this _____ day of___, 20___. Printed name:______________________________ ___________________________ My commission Notary Public expires on ___________. _________________________________________________________ Subscribed and sworn to before me Signature on this _____ day of___, 20___. Printed name:______________________________ ___________________________ My commission Notary Public expires on ___________. _________________________________________________________ Subscribed and sworn to before me Signature on this _____ day of___, 20___. ___________________________ My commission Notary Public expires on ___________. SPECIAL NOTICE The District of Columbia will provide the appropriate services and auxiliary aids, including sign language interpreters, whenever necessary to ensure effective communication with members of the public who are deaf, hearing impaired or who have other disabilities affecting communications. Requests for services and auxiliary aids should be made at least ten (10) days prior to any scheduled hearing. Please notify the ADA Coordinator at (202) 442-4423. American LegalNet, Inc. www.FormsWorkflow.com GOVERNMENT OF THE DISTRICT OF COLUMBIA ALCOHOLIC BEVERAGE REGULATION ADMINISTRATION INSTRUCTIONS FOR FILING APPLICATION FOR ALCOHOLIC BEVERAGE CONTROL (ABC) SOLICITOR'S LICENSE APPPLICATION Please read all questions carefully. Each question must be answered. If a question or one portion of the question does not apply; fill in the word "NONE". FEE: The application must be accompanied by the proper license fee. The Solicitor's annual fee is $325. Please see the attached prorated fee schedule. All payments can be made in the form of a cashier's check, certified check, business check, attorney's check, personal check, or money order, payable to the D.C. Treasurer, cash, or by credit card (except for American Express). · · · · · · · All persons applying for the Solicitor's License must be 21 years of age. Applications must be submitted in person, Monday through Friday, between the hours of 8:30 a.m. to 3:30 p.m. Please bring a valid government issued identification with you. Please note the term "APPLICANT" as used in this application designates the person in whose name the license will be issued if the application is approved. Your license may be issued the same day or it may be forwarded to the ABC Board for review. Please be advised that you need a separate solicitor's license for each company that employees you. Application forms must be notarized where applicable. Attach extra sheets if necessary. Write, "see attachment" in any space, and print your name on the top of each sheet. NOTE: The D.C. Department of Consumer & Regulatory Affairs (DCRA), Corporations Division and the Office of Tax and Revenue (OTR) are located at 941 North Capital Street, N.E., 1st Floor, Washington, DC 20002. Instructions for the Solicitor's Application: 1. Print applicant's name (Last Name, First Name, Middle Initial); 2. Print applicant's date of birth; 3. Print applicant's place of birth; 4. Print applicant's home telephone number; 5. Print applicant's home address (street number and name, city, state and zip code) 6. Check appropriate box, Yes or No, if you are eligible to work in the U.S. If yes, please bring in qualifying documents and provide the information requested in number 7; 7. Check the ap
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