Maine > Statewide > Liquor Licensing And Inspection Division
Off Premise Retail Application - Maine
| Off Premise Retail Application Form. This is a Maine form and can be used in Liquor Licensing And Inspection Division Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
DEPARTMENT OF PUBLIC SAFETY LIQUOR LICENSING AND INSPECTION UNIT NOTICE To avoid any delay in the processing of your application and issuance of your liquor license, please make sure that: 1. You completed the application in full. 2. Application is signed by the owner (s), Corporate Officer 3. The license fee is correct and you have included the $10.00 filing fee. 4. A diagram of the premises to be licensed accompanies the application. (For new applications only) 5. If business is located in an unorganized township. The application must be approved by the County Commissioners and the $10.00 filing fee paid to them. Limited Liability Companies, Limited Partnerships and Corporations must complete and submit the Supplementary Corporate Questionnaire. If not a publicly traded corporation, stock ownership must add up to 100%. American LegalNet, Inc. www.FormsWorkFlow.com DEPARTMENT OF PUBLIC SAFETY LIQUOR LICENSING AND INSPECTION UNIT Present License Expires________________ BUREAU USE ONLY LICENSE # ASSIGNED: Class: Deposit Date: Amt. Deposited: Off-Premise Retailer Malt Liquor ...................................................................................................................... $200.00 Off-Premise Retailer Table Wine ..................................................................................................................... $200.00 Filing Fee ............................................................................................................................................................. $ 10.00 NOTE: if the place of business is located in an unincorporated place, the County Commissioners must approve the application. All such applications shall be accompanied by receipt of payment of the $10.00 filing fee to the County Treasurer. Check Payable: Treasurer State of Maine ALL QUESTIONS MUST BE ANSWERED IN FULL 1. APPLICANT(S) (Sole Proprietor, Corporation, Limited Liability Co., etc.) DOB: 2. Business Name (D/B/A) DOB: DOB: Location (Street Address) Address City/Town State Zip Code Mailing Address City/Town State Zip Code City/Town State Zip Code Telephone Number Fax Number Business Telephone Number Fax Number Federal I.D. # Seller Certificate # 3. List of Wholesale Value and Types of Merchandise in inventory: (Must be answered) Edible Foods $ __________ Tobacco Products $ __________ Paper Goods $ __________ Greeting Cards, Magazines, Newspapers $ __________ $ __________ Total of all other merchandise in inventory No (If Yes 4. Is applicant a Corporation, Limited Liability Co. or Limited Partnership: Yes complete Corporate Questionnaire) 5. If manager is to be hired give name______________________________________________________ 6. If business is NEW indicate opening date: _____________ Business Hours: _____________________ 7. Is/Are applicant(s) citizens of the United States? Yes No American LegalNet, Inc. www.FormsWorkFlow.com DEPARTMENT OF PUBLIC SAFETY LIQUOR LICENSING AND INSPECTION UNIT 8. Is/Are applicant(s) residents of the State of Maine? Yes No 9. List name, date of birth, place of birth for all applicants and managers. Give maiden name, if married: Name in Full (Print Clearly) DOB Place of Birth Residence address on all of the above for previous 5 years (Limit answer to city & state) _____________________________________________________________________________________________________________________ _______________ Use a separate sheet of paper if necessary. 10. Has applicant(s) or manager(s) ever been convicted of any violation of the law, other then minor traffic violations of any State of the United States? Yes No Name: ______________________________________________ Date of Conviction: ________________________ Offense: ____________________________________________ ________________________________ Disposition: _________________________________________ 11. Will any law enforcement official benefit financially either directly or indirectly in our license, if issued? Yes No If Yes, give name: _____________________________________________________________ 12. Has applicant(s) formerly held a Maine liquor license? 13. Do applicant(s) own the premises? Yes __________________ No Yes No Location: If No, give name and address of owner: _____________________________________________________________________________________ __________ 14. Describe in detail where liquor will be stored: (Supplemental On/Off Premise Diagram Required)________________ _____________________________________________________________________________________ __________ 15. Have you received any assistance financially or otherwise (including any mortgages) from any source other than your- American LegalNet, Inc. www.FormsWorkFlow.com DEPARTMENT OF PUBLIC SAFETY LIQUOR LICENSING AND INSPECTION UNIT self in the establishment of your business? Yes ________________________________ No If Yes, give details: _____________________________________________________________________________________ 16. Does any other person have any interest directly or indirectly in your business? Yes No If Yes, give details: _____________________________________________________________________________________ _____________________________________________________________________________________ PAYMENTS TO THE DEPARTMENT OF PUBLIC SAFETY, LIQUOR LICENSING & INSPECTION DIVISION BY CHECK SUBJECT TO PENALTY PROVIDED BY SECTION 3 OF TITLE 28A, MAINE REVISED STATUTES NOTE: "I understand that false statements made on this form are punishable by law. Knowingly supplying false information on this form is a Class D offense under the Criminal Code, punishable by confinement of up to one year or by monetary fine of up to $500.00 or by both." Dated at: _________________________ on _______________,20_____ City/Town Date Year ___________________________________________ ___________________________________ __________________________________________ Signature(s) of Applicant(s) or Corporate Officer(s) ____________________________________ Print Name of Applicant(s) or Corporate Officer(s) STATE OF MAINE Liquor Licensing & Inspection Unit 164 State House Station Augusta, Maine 04333-0164 Tel: (207) 624-7220 Fax: (207) 287-3424 American LegalNet, Inc. www.FormsWorkFlow.com DEPARTMENT OF PUBLIC SAFETY LIQUOR LICENSING AND INSPECTION UNIT SUPPLEMENTARY QUESTIONAIRE FOR CORPORATE APPLICANTS, LIMITED LIABILITY COMPANIES AND LIMITED PARTNERSHIPS 1. Exact Corporate Name:______________________________________________________
|
|||||||
