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Application For State Of Illinois Retailers Liquor License IL 567-0015 - Illinois
| Application For State Of Illinois Retailers Liquor License Form. This is a Illinois form and can be used in Liquor Control Commission Statewide . |
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Illinois Liquor Control Commission Rod R. Blagojevich Governor 100 W. RANDOLPH ST. SUITE 7-801 CHICAGO, ILLINOIS 60601 TELEPHONE: 312-814-2206 FAX: 312-814-2241 TDD: 312-814-1844 101 W. JEFFERSON ST. SUITE 3-525 SPRINGFIELD, ILLINOIS 62702 TELEPHONE: 217-782-2136 FAX: 217-524-1911 WEB SITE: www.state.il.us/LCC APPLICATION FOR STATE OF ILLINOIS RETAILER'S LIQUOR LICENSE REMEMBER: YOU CANNOT PURCHASE OR SELL ALCOHOL WITHOUT A VALID STATE LIQUOR LICENSE! DEFINITION: A Retailer's Liquor License shall allow the licensee to sell and offer for sale at retail, only at the premises specified in such license, alcoholic liquor for use or consumption, but not for resale in any form; provided that any retail liquor license issued to a manufacturer shall only permit such manufacturer to sell alcoholic beverages at retail on the premises actually occupied by such manufacturer [235ILCS 5/5-1(d)], the only exception being a wine-maker's retail license--2nd location [235 ILCS 5/5-1(i)]. All applicants for licensing as a liquor "retailer" must complete this application form. Respond to all questions on the application and furnish all required supporting documents. Failure to do so will result in the rejection of the application and non-issuance of a state liquor license. RETAILER'S LIQUOR LICENSE FEE: $500.00 The following documents and information are REQUIRED prior to receiving for your state license: 1) Photocopy of Certificate of Insurance (not the "Policy Declaration") if alcohol will be consumed on-premise; 2) Photocopy of Current Local Liquor License (contact your local liquor commission); 3) If opening an existing business, please supply the following: · Prior State Liquor License (if applicable); · Bulk Sales Release Order--Address Release (call IL Dept. of Revenue at 312-814-3063 if applicable); · Proof of Purchase, ie, bill of sale, closing statement, or lease (the closing on the purchase of business MUST occur prior to applying for your state license); 4) Federal Employer Identification Number (FEIN) (call 800-829-3676 to apply for number); 5) Illinois Business Tax (IBT or Sales Tax) Number (if applicable, call 800-732-8866 to obtain number); 6) Check or Money Order payable to the "Illinois Liquor Control Commission" (the Commission does NOT accept U.S. currency/cash as payment. 7) This application with the information requested printed or typed in the spaces provided. This form MUST bear an Original Signature. NOTE: The date of expiration of your initial State license will coincide with the 12-month period that begins on the issue date of your local liquor license. In some cases, the term of your first year's State liquor license may be less than a full year in duration. IMPORTANT NOTICE: THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 5/1 ET SEQ.). DISCLOSURE OF THIS INFORMATION IS MANDATORY. FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE. FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER. IL 567-0015 (01/2007) Printed on Recycled Paper PAGE 1 OF 6 American LegalNet, Inc. www.FormsWorkflow.com FOR OFFICE USE ONLY LICENSE NO. DATE ISSUED EXPIRATION DATE COUNTER ! 1. Application for State of Illinois Retailer's Liquor License application, your license cerAPPLICANT - CORPORATE INFORMATION ! If you want your renewalcorrespondence sent to your tificate and other ILCC "corporate" address, please check the box at left. A. FEIN Enter your Federal Employer Identification Number (FEIN) in this box. The FEIN is a nine-digit number issued by the U.S. Internal Revenue Service. This number is used for verification purposes only. If you do not have an FEIN number, call 1-800-829-3676 for general information on how to apply and to obtain the forms you will need. FEIN # B. ILLINOIS BUSINESS TAX NUMBER (IBT OR SALES TAX NO.) Enter the eight-digit Illinois Dept. of Revenue Business Tax (Sales Tax) Number. YOU MUST HAVE THIS NUMBER IN ORDER FOR A LICENSE TO BE ISSUED. If you need to obtain this number, call the Illinois Department of Revenue in Chicago at 312-814-5232 or in Springfield at 217-785-3707. Or call toll-free at 800-732-8866. ILLINOIS BUSINESS TAX # C. TELEPHONE Enter the area code/telephone number/extension of the sole proprietorship, corporation, etc. AREA CODE/TELEPHONE NO. ( D. ) EXT. COUNTY Enter the county where the sole proprietorship, corporation, etc. is located. COUNTY E. NAME Enter the name of the sole proprietorship (assumed name), partnership, corporation (Illinois, national, or foreign), or limited liability company in this box. Note! This name must be consistent with the name printed on your local liquor license and on your Illinois Department of Revenue Sales Tax Registration Certificate. NAME F . ADDRESS Enter the street address, city, state, and Zip Code of the sole proprietorship, corporation, etc.. ADDRESS CITY STATE ZIP CODE IL 567-0015 (01/2007) PAGE 2 OF 6 American LegalNet, Inc. www.FormsWorkflow.com 2. STATUS OF BUSINESS Check the applicable box (assumed name/sole proprietorship, partnership, Illinois corporation, foreign corporation, limited liability company) which corresponds to your business' official papers filed with the Office of the Secretary of State. Based on the box that you check, provide the date of the filing of the sole proprietorship/assumed name with the county clerk; in the case of a copartnership, the date of formation of the partnership; in the case of an Illinois corporation, the date of its incorporation; in the case of a foreign corporation, the foreign state where it was incorporated and the date, as well as the date of its becoming qualified under the "Business Corporation Act of 1983" to transact business in the State of Illinois; in the case of a limited partnership, the date of formation of such partnership; or in the case of a limited liability company, the date of formation of such entity. NOTE! In the case of a sole proprietorship, Section 5/6-2 of the Illinois Liquor Control Act requires that the business owner reside within the jurisdiction that grants the local liquor license. A. B. C. D. E. ! ! ! ! ! SOLE PROPRIETORSHIP PARTNERSHIP ILLINOIS CORPORATION FOREIGN CORPORATION LIMITED LIABILITY COMPANY DATE FILED WITH COUNTY CLERK: DATE OF FORMATION: DATE OF INCORPORATION: STATE OF INCORPORATION: DATE FORMED: DATE QUALIFIED TO DO BUSINESS IN ILL: If "C" or "D" is checked, indicate your current Secretary
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