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Application For State Of Georgia One Day Or Special Event Alcohol Beverage Permit ATT-4SP - Georgia
| Application For State Of Georgia One Day Or Special Event Alcohol Beverage Permit Form. This is a Georgia form and can be used in Alcohol And Tobacco Division Department Of Revenue Statewide . |
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ATT-4SP (Revised 10/11) Georgia Department of Revenue Alcohol and Tobacco Division P.O. Box 49728 Atlanta, GA 30359-9728 Phone: (404) 417-4900 Page 1 STATE OF GEORGIA SPECIAL EVENT ALCOHOL BEVERAGE PERMIT APPLICATION Please note: Items must be received at least 10 business days prior to the date of the event. LICENSE FEE FOR NON-PROFIT $25 per event LICENSE FEE FOR PROFIT BEER WINE LIQUOR $50 $50 $100 Will any wine products be auctioned at this event? *Additional fees and documents are required. PRODUCTS TO BE SOLD / SERVED: BEER MIXED DRINKS WINE Allowed Six Events a Year ORGANIZATION OR BUSINESS NAME MAILING ADDRESS CITY ALCOHOL LICENSEE: FEDERAL EMPLOYER ID NO. EVENT APPROVED BY STATE ZIP CODE DATE OF EVENT (mm/dd/yyyy) Yes No TIME OF EVENT (0:00 pm/am) PLACE OF EVENT STREET ADDRESS CITY STATE ZIP CODE COUNTY SOCIAL SECURITY NUMBER (REQUIRED) GA. SALES TAX NO. CITY OF TELEPHONE NO. Work: ( ) Home: ( ) GA. WITHHOLDING NO. GA. BLDG. AUTHORITY SOCIAL SECURITY NUMBER (REQUIRED) COUNTY OF NAME OF PERSON RESPONSIBLE FOR THE EVENT (IF DIFFERENT FROM ALCOHOL LICENSEE) LIST OFFICERS AND RESIDENT ADDRESSES (REQUIRED) : 1. 2. SOCIAL SECURITY NUMBER (REQUIRED) To approve your application for the sale of alcoholic beverage at a Special Event to be hosted by a Qualified Non-Profit Civic Organization or a For Profit Organization the following items are required in addition to the completed application ***For Sunday events the local license/letter of approval must cover the Friday & Saturday before the event date for delivery purposes*** ***For Festivals an application must be submitted for each location that is selling or serving liquor*** 1. 2. 3. Qualified Non-Profit Civic Organization ONLY Furnish a copy of the local license, or letter of approval for the event from the local authorities, if available. Copy of corporate charter and by-laws or a copy of tax exempt status (501 C3 letter) from IRS. License fee of $25 per event (up to 3 days per event), not to exceed six events per year. After you have exceeded six events, the license fees will be treated the same as a For Profit Organization license fees (see below). Donated Wine Auction for Qualified Non-Profit Civic Organization ONLY 1. 2. 3. 1. 2. Furnish a copy of the local license, or letter of approval for the wine auction from the local authorities, if available. Include the Donated Wine Inventory List (Form CRF-015) for each donor. Include the appropriate fee: Wine Auction - $25 per event not to exceed six events per year. Furnish a copy of the local license, or letter of approval, for the event from the local authorities. Include the appropriate fees: Beer - $50 Wine - $50 Liquor - $100 Include the Liquor Bond (Form ATT-59) if you are planning on selling/serving Liquor. All laws and regulations relating to the sale of alcoholic beverages must be complied with. It is understood that the person named herein is in charge and responsible for the event, and all officers of the organization may be held liable and responsible for any violation of law or regulation. Georgia Sales Tax must be remitted to the State on all Sales at this event. If the organization does not hold a Georgia Sales Tax number the organization must file a miscellaneous sales tax return. For Profit Organization 3. NOTE: SIGNATURE SECTION I DECLARE UNDER PENALTY OF FALSE SWEARING, THAT THIS APPLICATION HAS BEEN EXAMINED BY ME, AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IS TRUE, CORRECT, AND COMPLETE. I FURTHER CERTIFY I AM IN COMPLIANCE WITH ALL STATE AND LOCAL LAWS AND REGULATIONS. Signature Date (THIS APPLICATION MUST BE SIGNED BY THE ALCOHOL LICENSEE. IF THE LICENSEE IS A CORPORATION, AN ACTIVE OFFICER OR MANAGING MEMBER MAY SIGN THE APPLICATION. A STAMPED SIGNATURE IS NOT ACCEPTABLE.) American LegalNet, Inc. www.FormsWorkFlow.com ATT-4SP (Revised 10/11) Page 2 Affidavit of Compliance with O.C.G.A. 50-36-1 "Verification of Lawful Presence within the United States" O.C.G.A. 50-36-1 requires that applicants applying for such things as licenses for public benefits complete a signed and sworn affidavit verifying the applicant's lawful presence in the United States. Therefore, the applicant must answer the following questions: The applicant is a United States citizen or legal permanent resident at least eighteen (18) years old. Yes ______ No ______ The applicant is a qualified alien or nonimmigrant under the federal Immigration and Nationality Act, Title 8 U.S.C., as amended, at least eighteen (18) years old, and is lawfully present in the United States. The applicant's alien number issued by the Department of Homeland Security or other federal immigration agency must be provided. Yes ______ No ______ Alien Number ____________________________________ O.C.G.A 50-36-1 states that "Any person who knowingly and willfully makes a false, fictitious, or fraudulent statement of representation in an affidavit executed pursuant to this Code section shall be guilty of a violation of Code Section 16-10-20." I declare, under penalty of law, that this affidavit has been completed by me and is true and correct. ___________________________________________________________________________________________ Signature Title Date (Must be signed by applicant. If the applicant is a corporation, must be signed by an officer of the corporation. STAMPED SIGNATURE IS NOT ACCEPTABLE) I hereby certify that__________________________________________________________ is personally known, or verified by me, that the applicant signed this application after stating to me his or her personal knowledge and understanding of all statements and, under oath actually administered by me, has sworn that the statements and answers contained in this affidavit are true. This _________ day of _____________, ______ . AFFIX SEAL _______________________________________ Notary Public You must attach a copy of a secure and verifiable document as defined in O.C.G.A. 50-36-2. Such documents include a valid Georgia issued Driver's License or ID Card, a valid Driver's License issued by another State or an identification document issued by the United States Government. American LegalNet, Inc. www.FormsWorkFlow.com
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