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Application For State Of Illinois Special Event Retailers Liquor License IL 567-0028 - Illinois
| Application For State Of Illinois Special Event 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 SPECIAL EVENT RETAILER'S LIQUOR LICENSE (NOT-FOR-PROFIT) DEFINITION: A Special Event Retailer's License (Not-for-Profit) shall permit the licensee to purchase alcoholic liquors from an Illinois licensed distributor (unless the licensee purchases less than $500 of alcoholic liquors for the special event, in which case the licensee may purchase the alcoholic liquors from a licensed retailer), and shall allow the licensee to sell and offer for sale, at retail, alcoholic liquors for use or consumption, but not for resale in any form, and only at the location and on the specific date(s) designated for the special event on the license. An "event" can be defined as a single theme. A Special Event Retailer's License must be obtained for each single theme per location with a maximum duration of 15 days. All not-forprofit corporations are required to secure a license for each 15-day increment and each special "event". ELIGIBILITY: The Special Event Retailer's License (Not-for-Profit) application form is to be used only for events conducted by an educational, fraternal, political, civic, religious or not-for-profit organization. DO NOT use this form if you have a current Illinois Retailer's liquor license (see Special Use Permit license instructions). Local liquor licensing authority approval is required for this license. Dram shop insurance to the maximum limit is required for this license. FEE: $25.00 PER APPLICATION, IF THE EVENT IS: 1) A SINGLE THEME; 2) AT THE SAME LOCATION FOR NOT MORE THAN 15 DAYS FROM START TO FINISH; AND 3) APPLICATION IS RECEIVED AT LEAST 14 DAYS IN ADVANCE. ADD AN ADDITIONAL $25.00 TO EACH APPLICATION FEE IF YOU EXPECT THAT THE APPLICATION WILL NOT BE RECEIVED AT COMMISSION OFFICES AT LEAST 14 DAYS PRIOR TO THE SCHEDULED EVENT (LEAD TIME REQUIRED IN ORDER TO SCHEDULE SITE INSPECTIONS). NOTE: "FOR-PROFIT" ORGANIZATIONS WHICH CURRENTLY DO NOT HOLD A STATE LIQUOR LICENSE and wish to hold a special event will be required to obtain a standard Retailer's Liquor License for $500.00 that covers the date(s) of the special event. This is the only way you will be able to purchase alcoholic beverages from a distributor. You will need to fill out the standard Retailer's Liquor License application form (IL 567-0015). PRIVATE PARTY is an event where attendance is by invitation only, the host controls access to the premises, and alcoholic beverages are provided to invited guests at no charge. A Special Event Liquor License is not required for a private party. ON THE FOLLOWING PAGES, PLEASE PRINT OR TYPE THE INFORMATION REQUESTED IN THE SPACES PROVIDED. THE FORM MUST BEAR AN ORIGINAL SIGNATURE, THEREFORE NO FAXED SIGNATURES OR FORMS WITH PHOTOCOPIED/RUBBER STAMPED SIGNATURES WILL BE ACCEPTED. 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 567-0028 (07/2005) Printed on Recycled Paper Page 1 of 4 American LegalNet, Inc. www.FormsWorkflow.com FOR OFFICIAL USE ONLY FOR OFFICE USE ONLY LICENSE NO. DATE ISSUED COUNTER ! EXPIRATION DATE Application for State of Illinois Special Event Retailer's Liquor License 1. APPLICANT INFORMATION Provide the corporate/organization name; provide the corporate/organization Federal Employer Identification Number (FEIN); provide your corporate/organization mailing address; county; and telephone number. NAME FEDERAL EMPLOYER ID NO. ADDRESS CITY STATE ZIP CODE COUNTY AREA CODE/TELEPHONE NO. ( ) 2. CERTIFICATION Public Act 90-596 was enacted to ensure that special event holders pay all required sales taxes if they hold more than two special events during a calendar year or if they are not a valid "not-for-profit" organization. Applicants for Special Event Retailer Not-for-profit Liquor licenses must now certify that both of the following conditions apply to this particular special event. Please check the boxes that apply. If either box is left unchecked, the Commission will issue this license as "NON-CERTIFIED" which may require the organization to pay sales taxes on the gross receipts from all sales of food and beverages at the event. The certifying officer must be listed under Section 5 of the application, having provided all required identifying information. Should you have any questions regarding sales tax liability or sales tax registration information, please call the Department of Revenue Toll Free Hotline at 800-732-8866. ! I hereby certify that the organization which is applying for this Special Event Retailer Not-for-profit Liquor license is a valid "not-for-profit" entity which holds either a resale number [a resale sales tax number] issued under Section 2(c) of the Retailers' Occupation Tax Act; a sales tax registration [a sales tax number] under Section 2(a) of the Retailers' Occupation Tax Act; or a current, valid exemption identification number [a tax-exempt "E" number] issued under Section 1(g) of the Retailers' Occupation Tax Act. hereby certify that the organization which is applying for Retailer Not-for-profit ! ILiquor license has held no more than two such special events this Special Eventcalendar year (January during the current 1 - December 31). This special event must be included in your calculation. Signature of Applicant Title of Applicant Date 3. STATUS OF ORGANIZATION Check appropriate box and provide sales tax exemption details. ! ! ! ! ! ! A. B. C. D. E. F. EDUCATIONAL FRATERNAL POLITICAL CIVIC RELIGIOUS OTHER NOT-FOR-PROFIT DATE OF INCORPORATION: OR ATTACH AN ILLINOIS DEPARTMENT OF REVENUE SALES TAX EXEMPTION LETTER (SPECIFY) Printed on Recycled Paper IL 567-0028 (07/2005) Page 2 of 4 American LegalNet, Inc. www.FormsWorkflow.com 4. SPECIAL EVENT DETAIL · · · · · Provide the date(s) and time(s) that the event will be held. When you receive your printed license certificate from the Commission, times will be listed in military time; i.e. "0200" = 2AM, "1200" = noon"; "2400" =
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