West Virginia > Statewide > Alcohol Beverage Control Commission
Application For Retail License On Premise - West Virginia
| Application For Retail License On Premise Form. This is a West Virginia form and can be used in Alcohol Beverage Control Commission Statewide . |
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State of West Virginia Department of Revenue Alcohol Beverage Control Administration th 322 70 Street, SE Charleston, WV 25304-2900 INSTRUCTIONS FOR COMPLETING APPLICATION FOR RETAIL LICENSE - ON PREMISE PLEASE READ ALL INSTRUCTIONS CAREFULLY. ALL QUESTIONS ARE TO BE ANSWERED IN FULL. APPLICANT'S ACCURACY AND THOROUGHNESS IN COMPLETING THE APPLICATION FORM WILL ASSIST THIS OFFICE IN PROCESSING THE APPLICATION AND PREVENT UNNECESSARY DELAYS. APPLICANTS MUST TYPE OR PRINT, IN INK, ALL ANSWERS ON ALL FORMS Please find enclosed: 1. Application for Retail License, Consumption On Premise, Class A (ABCA-192A) 2. Floor Plan (ABCA-Lic.FP3), give dimensions of licensed premises 3. Release of Information & Waiver of Confidentiality of Records (ABCA-Lic.RIWCR.2) 4. Alcohol Beverage Control Bond (ABCA-193) and Nonintoxicating Beer Bond (ABCA-194) 5. Zoning Form (ABCA-Lic.Z.2) INSTRUCTIONS All questions and/or descriptions must be answered. The application must be signed and notarized. If any question/description cannot be completed in the available space on the application, please submit additional pages as needed. Be sure to indicate on the additional pages which question applicant is answering (print Entity and DBA Name on the additional pages). Applications must be completed correctly and all necessary paperwork included when mailed to the ABCA. Failure to do so will result in the application being delayed and/or returned to the applicant for the necessary corrections. LICENSE FEES - License fees must be paid by Certified Check, Cashier's Check, or Money Order. Personal checks, business checks, or cash will not be accepted. Make checks payable st to the West Virginia ABCA. If applying for a license after December 31 , the license fee is semi-annually pro-rated to half the initial fee. A processing fee of twenty-four ($24.00) dollars must be included for each individual listed for Live Scan Fingerprinting. BONDS Applicants must have a $5,000.00 Alcohol Beverage Control Bond and/or a $1,000.00 Nonintoxicating Beer Bond completed on the form(s) provided by the ABCA. (Instructions continued on the back side of this page) ABCA-Lic.IA American LegalNet, Inc. www.FormsWorkFlow.com HEALTH PERMIT Applicants must provide a copy of a valid Health Permit issued in applicant's name. (If Association, Limited Liability Company or Corporation, the health permit must be issued in the business entity name.) WV SECRETARY OF STATE All Associations, Corporations, Limited Liability Corporations, Non-Profit Clubs, and Fraternal Organizations must be duly certified and registered with the WV Secretary of State. Fraternal Organizations must contact the ABCA Licensing Department for additional requirements. INSTRUCTIONS FOR SIGNING: a. If an individual, by the owner b. If a partnership, by each member of the partnership c. If an association, by each member of the governing board d. If a corporation, by all officers, or by other persons specifically authorized by corporate resolution (copy of resolution must be enclosed) e. If a limited liability company, by all members f. Manager(s) must sign All applicants must apply for a "Special Occupation Tax (TTB F 5630.5d)" with the Alcohol and Tobacco Tax and Trade Bureau. Form and instructions are available by calling the toll-free number at 800-937-8864 or through download at the following website: http://www.ttb.gov/forms/5630d.pdf BUSINESS CLOSURE Upon sale or closure of the applicant's business, the license must be returned to the ABCA Licensing Department. The license will not be abandoned, rented, leased, given, loaned, or sold to another. MAIL COMPLETED APPLICATION, FEES, AND REQUIRED ACCOMPANYING FORMS TO: West Virginia Alcohol Beverage Control Administration ATTN: Licensing Department th 322 70 Street SE Charleston, WV 25304-2900 IF YOU HAVE ANY QUESTIONS OR NEED ASSISTANCE PLEASE CALL THE ADMINISTRATION AT 1-800-642-8208 OR (304) 558-2481 AND ASK FOR THE LICENSING DEPARTMENT. CHECKLIST OF FORMS/PAPERS TO RETURN TO THE WVABCA, LICENSING DEPARTMENT: Application Form License fee(s) and Live Scan Processing Fee(s) Alcohol Bond, if applicable* Nonintoxicating Beer Bond Floor Plan Waiver Zoning Form and Letter from County Commission, if applicable Copy of Valid Lease (if not owner) *Bond not required for private wine restaurant license ABCA-Lic.IA American LegalNet, Inc. www.FormsWorkFlow.com ABCA 192A REVISED 3/11 WEST VIRGINIA ALCOHOL BEVERAGE CONTROL ADMINISTRATION APPLICATION FOR RETAIL LICENSE CONSUMPTION "ON PREMISE" CLASS A FOR FISCAL YEAR _______ TO _______ COUNTY: ___________________ PLEASE CHECK ALL APPROPRIATE BOXES BELOW. BE SURE TO CHECK THE BOX(ES) BESIDE EACH (ALL) OF THE LICENSES FOR WHICH YOU ARE APPLYING. A. LIQUOR APPLICATION Fraternal Club......................$900* Private Club (less than 1000 members)....$1,150* Private Club (more than 1000 members)..$2,650* Off Premises Wine Sales..........................$100 *These fees include liquor, wine, and beer. B. WINE APPLICATION C. BEER APPLICATION D. APPLYING AS: (CHECK ONE) Individual Partnership Limited Partnership Corporation Association Limited Liability Co. Private Wine Tavern, Restaurant...........................$250 Restaurant, Etc.............$150 Private Wine Spa...................$150 Fraternal......................$150 Private Wine Brew Pub...................$1,000 Bed & Breakfast...................$150 Off Premises Wine Sales..........................$100 These fees do not include liquor or beer. These fees do not include liquor or wine. Only Associations, Corporations, or Limited Liability Companies may apply for a liquor license. Email: 1. Licensee/Entity Name: 2. Doing Business As (DBA) Name: 3. Business Address: Fax Number: _______________ WV TAX I.D./FEIN: _____________________ (STREET) (CITY) (STATE) (STREET) (CITY) (STATE) (ZIP CODE) (TELEPHONE) (ZIP CODE) (TELEPHONE) 4. Mailing Address (if different): 5. SUPPLY THE FOLLOWING INFORMATION ABOUT OWNER(S) AND/OR OFFICER(S) AND MANAGER(S). US Citizen ** _____________ TITLE NAME _____/______/______ DATE OF BIRTH ____________________________________________________________ ___________ RESIDENCE ADDRESS ___________-___________-____________ SOCIAL SECURITY NUMBER ( ______ )__________________________________ TELEPHONE NUMBER % OWNERSHIP ______________________ YRS RESIDENT OF WV Y/N _____________ TITLE NAME _____/______/______ DATE OF BIRTH ____________________________________________________________ ___________ RESIDENCE ADDRE
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