Kentucky > Statewide > Alcohol Beverage Control > Licensing
Schedule Temporary License - Kentucky
| Schedule Temporary License Form. This is a Kentucky form and can be used in Licensing Alcohol Beverage Control Statewide . |
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Schedule Temporary March, 2011 COMMONWEALTH OF KENTUCKY DEPT. OF ALCOHOLIC BEVERAGE CONTROL 1003 Twilight Trail Frankfort, Kentucky 40601-8400 (502) 564-4850 phone (502) 564-1442 fax http://abc.ky.gov Site I.D. # SCHEDULE "TEMPORARY" LICENSE Applications may be returned if all questions are not answered completely. LEAVE BLANK FOR ABC USE ONLY License # ______________ $_______________ Val._______________ License # ______________ $_______________ Val._______________ License #_______________ $_______________ Val. ____________ License# _______________ $_______________ Val. ____________ Malt Beverage Administrator's Approval _____________________________________________________ Date ___________________________ Distilled Spirits Administrator's Approval ____________________________________________________ Date ___________________________ (A). Name of person(s) or company to be licensed ____________________________________________________________________________ Name of this special event _______________________________________________________________________________________________ Address of premises to be licensed ________________________________________________________________________________________ (Where the alcoholic beverages will be sold) City __________________________________ County _________________________ State ________ 9 digit zip code ____________________ Mailing address if different from above _____________________________________________________________________________________ Contact person 8:00 am 4:30 pm ______________________________________________________ e-mail address _____________________ Contact phone__________________________________________________________Fax ___________________________________________ List the type(s) of temporary license(s) you are applying for ____________________________________________________________________ (B). 1. Amount of fee enclosed...(Make certified check, cashier check or money order payable to Kentucky State Treasurer)....... $_______. (See fee chart on the back page of this application) 2. Period to be covered by license from (month) __________________(day) __________(year) ________. Through (Month) ____________________(day) __________(year) ________. (Each event requires a separate application, fee and license.) 3. 4. WHAT IS THE DATE (S) AND TIME (S) OF YOUR SPECIAL EVENT? __________________________________________________. Kentucky law limits temporary licenses to public events. Therefore, do you agree not to exclude the public from this special event? 5. Are you the owner of the real estate where the premises are to be licensed? If no, attach a copy of your lease or letter of permission to use this property, signed by you and the owner of the real estate. List the real estate owner's name. _________________________________________________________________. Yes No Yes No (C). 6. Complete the following for the business proprietor, partner(s) and all persons interested in the business to be licensed. List all owners, officers, directors, partners, managing members, members, and shareholders (unless publicly held). Show 100% of the ownership. If additional space is needed, please make an attachment. USA CITIZEN LIST DATE & STATE WHERE YOU RESIDED IN PAST 5 YRS. NAME AND ADDRESS ALL PHONE NUMBERS H = HOME W = WORK F = FAX 0 = OTHER H W F O H W F O SOCIAL SECURITY NUMBER TITLE DATE OF BIRTH % OF OWNERSHIP % % Yes No Yes No American LegalNet, Inc. www.FormsWorkFlow.com Schedule Temporary March, 2011 (D). 7. Are the premises to be licensed located within an incorporated city or town? If yes, list the name of the city or town. __________________________________________________________. Is the entire license fee paid by the applicant and by no other person? Is the applicant a corporation, limited partnership, or limited liability company, in good standings with the Kentucky Secretary of State? Has the applicant(s) been licensed to sell alcoholic beverages? If yes, list your state ABC license number(s)._______________________________________________________. Has the applicant or any person named in statement 6 been convicted of any felony in the past five (5) years? Has the applicant or any person named in statement 6 been convicted of a misdemeanor directly or indirectly related to alcohol or a controlled substance in the past two (2) years? If yes, you must attach a statement giving a full explanation, including dates of convictions. Has the premises to be licensed or any person listed in this application had a ABC license suspended or revoked, or an ABC application denied? If yes, you must attach a statement giving a full explanation, including dates of suspension, revocation or denial. Site ID # Yes No Yes No Yes No Yes No Yes No Yes No 8. 9. 10. 11. 12. Yes No 13. 14. Give a description for the purpose of this special temporary license. The following information must be provided before issuance of the temporary license. We will need detailed information including the type of activities being held, number of people attending the event, the type of entertainment being used and a list of food and beverages you will provide. Let us know if there are any caterers being used and if so, does this caterer hold an ABC caterer's license? Will they be serving any alcoholic beverages using their ABC caterer's license? Do you plan to provide any alcoholic beverage tastings at your event? If so, explain in detail what you will offer. Attach copies of any advertising, mailers, invitations or handbills you are using for this event. Include any other information you feel will help our State Administrators determine if this event should be granted a temporary ABC license. _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ List the persons or non-profit, charitable, civic or political organization that will receive the proceeds from the sales of alcoholic beverages under this Special Temporary License. ________________________________________________________________________________ (E). AFFIDAVIT OF PERSON APPLYING FOR THE KENTUCKY ABC LICENSE(S) I
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