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Application For State Of Illinois Non-Beverage Users License Alcoholic Liquor IL 567-0027 - Illinois
| Application For State Of Illinois Non-Beverage Users License Alcoholic Liquor 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 NON-BEVERAGE USER'S ALCOHOLIC LIQUOR LICENSE DEFINITION A non-beverage user's license shall allow the licensee to purchase alcoholic liquor from a licensed manufacturer or importing distributor, without the impostion of any tax upon the business of such licensed manufacturer or importing distributor as to such alcoholic liquor to be used by such licensee solely for the non-beverage purposes set forth in Section 8-1 of the Illinois Liquor Control Act, and such licenses shall be divided and classified and shall permit the purchase, possession and use of limited and stated quantities of alcoholic liquor. ! ! ! ! ! 500 Gal. . . . . . . . . . . . . . . $24.00 CLASS 1 . . . . . . . . . . . . . . . . . . . Not to exceed . . . . . . . . . . CLASS 2 . . . . . . . . . . . . . . . . . . . Not to exceed . . . . . . . . . . 1,000 Gal. . . . . . . . . . . . . . . $60.00 CLASS 3 . . . . . . . . . . . . . . . . . . . Not to exceed . . . . . . . . . . 5,000 Gal. . . . . . . . . . . . . . . $120.00 CLASS 4 . . . . . . . . . . . . . . . . . . . Not to exceed . . . . . . . . . . 10,000 Gal. . . . . . . . . . . . . . . $240.00 CLASS 5 . . . . . . . . . . . . . . . . . . . Not to exceed . . . . . . . . . . 50,000 Gal. . . . . . . . . . . . . . . $600.00 ! NO FEE Hospitals, Sanitariums or Clinics, Universities, Colleges of Learning or Schools, (when the use of alcoholic liquor is strictly medicinal, mechanical, or scientific) and Laboratories (when the use of alcoholic liquor is exclusively for the purpose of Scientific Research) are not required to pay a fee for a non-beverage user's license. 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 567-0027 (03/2006) Printed on Recycled Paper Page 1 of 4 American LegalNet, Inc. www.FormsWorkflow.com FOR OFFICE USE ONLY LICENSE NO. DATE ISSUED EXPIRATION DATE Application for State of Illinois Non-Beverage User's License Alcoholic Liquor A. CORPORATE/BUSINESS(DBA) INFORMATION 1. 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. NOTE, if you have filed an application for your FEIN number, the Commission will accept your application. FEIN # 2. TELEPHONE Enter the area code/telephone number/extension of the corporation, partnership etc. AREA CODE/TELEPHONE NO. ( 3. ) EXT. COUNTY Enter the County in which the business is located. COUNTY NAME 4. CORPORATE NAME (Also list trade or business name, if different from corporate name) Enter the name of the corporation (Illinois, national, or foreign), partnership or limited liability company in this box. CORPORATE NAME DBA NAME 5. ADDRESS (Location of place of business for which application is made) Enter the street address, city, state, and Zip Code of the corporation, partnership, etc.. ADDRESS CITY STATE ZIP CODE 6. IL SECRETARY OF STATE CORPORATION FILE NUMBER (If applicable) FILE NUMBER 7. DATE OF INCORPORATION/REGISTRATION (If applicable) DATE OF INCORPORATION/REGISTRATION IL 567-0027 (03/2006) Printed on Recycled Paper Page 2 of 4 American LegalNet, Inc. www.FormsWorkflow.com A. CORPORATE/BUSINESS(DBA) INFORMATION (CON'T) 1. PREVIOUS NON-BEVERAGE USER LICENSE NUMBER (If applicable) NON-BEVERAGE LICENSE NO. 2. STATE NATURE OF BUSINESS Enter the Corporate Entity type of business NATURE OF BUSINESS 3. PURPOSE FOR WHICH ALCOHOLIC LIQUORS ARE TO BE USED 4. PERSON COMPLETING APPLICATION Enter the Name, Title/Position, and Telephone number of the person completing this application. NAME TITLE/POSITION TELEPHONE NO. B. OWNERSHIP INFORMATION For each owner/officer/partner/5% or greater shareholder, provide the following: full name, home address, city, state, Zip Code, social security number, date of birth, sex, title/position, home telephone number, and percentage of ownership. NAME (LAST, FIRST, MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP SOCIAL SECURITY NO. DATE OF BIRTH SEX TITLE/POSITION AREA CODE/TELEPHONE NO. % OWNED ( NAME (LAST, FIRST, MIDDLE INITIAL) HOME ADDRESS CITY ) STATE ZIP SOCIAL SECURITY NO. DATE OF BIRTH SEX TITLE/POSITION AREA CODE/TELEPHONE NO. % OWNED ( NAME (LAST, FIRST, MIDDLE INITIAL) HOME ADDRESS CITY ) STATE ZIP SOCIAL SECURITY NO. DATE OF BIRTH SEX TITLE/POSITION AREA CODE/TELEPHONE NO. % OWNED ( ) IL 567-0027 (03/2006) Printed on Recycled Paper Page 3 of 4 American LegalNet, Inc. www.FormsWorkflow.com B. OWNERSHIP INFORMATION (CON'T) ADDITIONAL MEMBERS/OFFICERS (if needed) NAME (LAST, FIRST, MIDDLE INITIAL) HOME ADDRESS CITY STATE ZIP SOCIAL SECURITY NO. DATE OF BIRTH SEX TITLE/POSITION AREA CODE/TELEPHONE NO. % OWNED ( NAME (LAST, FIRST, MIDDLE INITIAL) HOME ADDRESS CITY ) STATE ZIP SOCIAL SECURITY NO. DATE OF BIRTH SEX TITLE/POSITION AREA CODE/TELEPHONE NO. % OWNED ( NAME (LAST, FIRST, MIDDLE INITIAL) HOME ADDRESS CITY ) STATE ZIP SOCIAL SECURITY NO. DATE OF BIRTH SEX TITLE/POSITION AREA CODE/TELEPHONE NO. % OWNED ( ) AFFIDAVIT The above information supplied for the purpose of inducing the Illinois Liquor Control Commission to issue a Non-Beverage User's license to the applicant herein is true and correct and made upon my personal knowledge and information. I further swear or affirm that the applicant will not violate any of the laws of the United States of America or the State of Illinois, in particular, the Illinois Liquor Control Act, Rules and Regulations, and the civil rights sections thereof. Signature of Applicant or Authorized Agent Signature of Applicant or Authorized Agent Title or Position Title or Position Date Signed Date Signed NOTE: If the license is to be issued to a partnership, two partners must sign. If the license is to be issued to a corporat
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