District Of Columbia > Statewide > Alcoholic Beverage Regulation Administration
Temporary License Application - District Of Columbia
| Temporary License 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 TEMPORARY LICENSE APPLICATION OFFICIAL USE ONLY License Number: __________________ Class: _____ F _____ G Date Accepted: ______________________ Fees Paid: $_______ From _________ To ________ Issue Date:________ Board Approved Date:_________ Ward (ANC): ____________ Accepted By: ___________________ From _________ To ________ Board Member's Initials: ________ ________ ________ ________ ________ ________ ________ TO BE COMPLETED BY APPLICANT 1. Are you a Metropolitan Police Officer? 2. Applicant's Name (Last, First, Middle Initial): Yes No If yes, Do Not Proceed. 3. Applicant's Residential Address: 4. Date of Birth: 5. Place of Birth: 6. Age: 7. Home Telephone Number: 8. Business Telephone Number: 9. Organization Sponsoring Event: 10. Date(s) of Event: 11. Portion of Premises to Be Used? 12. Address of Premises: 13. Hours of Event? 14. Hours of Sales and consumption of Alcoholic Beverages? 15. Are you eligible to work in the United States? Yes No If naturalized Citizen (attach copy) Give date, place and certificate number:____________________________________________________________________ 15a. If applicable, attach copy of the following document: Visa Number: ______________________________ Green Card Number: _____________________________ Work Permit:____________________ Expiration Date:_________ 16. Have you been convicted of a misdemeanor during the last five (5) years or convicted of a felony during the last ten (10) years? Yes No (If yes, attach a copy of date(s), charge(s) and disposition(s)) 17. Describe Event: 18. Who will manage the event? Applicant Designee (If designee, a manager's license is required) 20. What will be the dress code? 19. What is the age group that will be attending the event? 21. Is a Special Events License, as defined on the coversheet, needed? Yes (If yes, please provide proof of payment and obtain the sign off for your special event from the DCRA's Special Events Coordinator, located at 941 North Capitol Street, N.E., 7th Floor). No Special Events Coordinator Signature:___________________________________________ Date: ________________________ American LegalNet, Inc. www.FormsWorkflow.com 22. How many persons are you expecting to attend? 23. How will patrons pay to participate? Tickets Cash Bar At the door, indicate price $__________ No Cost 24. How many security individuals will be hired for the event if 25. What is the name of the security company, if applicable? (MPD cannot serve as Security) applicable? 26. What type of entertainment will be provided? 27. Indicate the type of music that will be featured? (Check All That Apply) Soul Calypso Rock Jazz Reggae Rhythm & Blues Other 28. What type of food do you plan to serve? 29. Will your food be catered? No Yes (If yes, what is the name of the caterer) Go-Go Salsa Gospel 30. What arrangements have you made for parking? 31. List the Washington, D.C. Retailer/Wholesaler from whom you plan to purchase alcoholic beverages: 1. _____________________________________________________ 3. _____________________________________________________ 32. 2.__________________________________________________ 4. __________________________________________________ CERTIFICATION / AFFIDAVIT I, being duly sworn, depose and say I am the individual who executed the foregoing application for an alcoholic beverage license, that this license authorizes me to sell, alcoholic beverages, in open containers, for consumption on the premises on a temporary basis; that the answers to the forgoing questions and other statements contained in this application are true to the best of my knowledge and belief; I have purchased and read Title 25 of the D.C. Official Code and Title 23 of the District of Columbia Municipal Regulations. These documents contain the laws and regulations for conducting an alcoholic beverage business and I understand that I will be held responsible for complying with the laws and regulations contained therein. I further hereby authorize the Alcoholic Beverage Control Board and/or its employees to investigate all of the information contained herein. _______________________________________________ Signature ______________________________________________ Print Name/Title Subscribed and sworn to before me this _______ Day of _______, 200___ Notary Public ________________________________ My Commission expires on: ______________________ 33. Please answer the question: In what language do you need vital documents translated, if any? 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 days prior to any scheduled hearing. Please notify the ADA Coordinator at (202) 442-4423. American LegalNet, Inc. www.FormsWorkflow.com SPECIAL NOTICE GOVERNMENT OF THE DISTRICT OF COLUMBIA ALCOHOLIC BEVERAGE REGULATION ADMINISTRATION INSTRUCTIONS FOR FILING APPLICATION FOR ALCOHOLIC BEVERAGE CONTROL (ABC) TEMPORARY LICENSE APPLICATION 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". Applications must be filed at least ten (10) days prior to the event. If the event is to be held outside on public space or considered a special event, applications must be filed at least forty-five (45) days prior to the event. Holders of ABC License classes A, B, C or D cannot apply for an ABC Temporary License. Metropolitan Police Officers are prohibited from holding an ABC license in the District of Columbia. All persons applying for the Temporary License must be 21 years of age. The applicant or an approved ABC manager must be present during the event. The ABC Board reserves the right to require additional approved ABC managers. Please attach a copy of the approved Manager's License. 3. Applications must be submitted in person, Monday through Friday, between the hours of 9:00 a.m. to 4:00 p.m. Please bring valid government issued identification with you. 4. 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. Please note that if this applicant wishes to designate another in
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