Louisiana > Statewide > Office Of Alcohol And Tobacco Control
Application For Notice Of Intent Posters - Louisiana
| Application For Notice Of Intent Posters Form. This is a Louisiana form and can be used in Office Of Alcohol And Tobacco Control Statewide . |
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For Office Use Only NOI Posters for all Retail Alcoholic Beverage Permits Office of Alcohol and Tobacco Control 8585 Archives Ave., Suite 220 Baton Rouge, LA 70809 Telephone: 225.925.4041 Fax: 225.925-7652 www.atc.rev.state.la.us Permit #: NOTICE OF INTENT POSTER REQUIRED FOR ALL RETAIL ALCOHOLIC BEVERAGE PERMITS VALID FOR 90 DAYS Page 1 of 2 IMPORTANT NOTICE If you are starting a new business, this application must be completed, signed, notarized, and submitted, along with the appropriate fees at least 15 days prior to submitting your application for an alcoholic beverage permit; If you are taking over an ongoing business that has held a valid, state-issued alcoholic beverage permit within the past 6 months, the alcoholic beverage permit application may be submitted, along with this application; As required by law, the Notice of Intent poster must be posted in plain view outside the business location for 15 days. PERMIT CLASS AND TYPE 1. Please mark the Class of permit that you desire: Class A General (On-Premises Consumption) [RS 26:71.1(1) / 271.1(1) Class A Restaurant (On-Premises Consumption) [RS 26:73(c)/273(c)] Class A Caterer (LAC 55, VII 325) 2. Please mark the Type of alcoholic beverage(s) that you intend to sell: Beer Liquor Light Wine (Not needed if Liquor is checked; Must have "R" permit) Class B (Off-Premises Consumption ONLY) [RS 26:2(13) / 241(13)] Class C (Off-Premises Consumption ONLY) [RS 26:71.2(13 )/ 271.2] BUSINESS INFORMATION 3. Type of Ownership Individual Partnership Corporation LLC 4. Owner Name of Business (Individual, Partnership, Corporation, LLC) 6. Trade Name of Business 7. Location Parish 5. Location Address Street City State Zip Yes No 8. Has this location held a valid, state-issued beer/liquor permit within the last 6 months? If Yes, enter the trade name under which the business operated: Trade Name . APPLICANT INFORMATION 9. Applicant's Name 11. Mailing Address P. O. Box/Street City State Zip 10. Driver's License # and State Issued DL# State 12. Contact Information Cell ph. # ( ) ) Work ph. # E-mail Address ) - Home ph. # ( American LegalNet, Inc. www.FormsWorkFlow.com FEES 13. Please check the type of alcoholic beverage to be served, and enclose the appropriate amount with this application: $50.00 BEER (Low Alcohol Content) $50.00 LIQUOR (High Alcohol Content) $50.00 LIGHT WINE ONLY Not needed if Liquor is checked; "R" Permit is required. NOTE NO REFUNDS will be made once this application packet and fees have been reviewed by this office; Our office accepts: money orders, cashier's checks and certified checks. DO NOT SEND CASH OR PERSONAL/BUSINESS checks; Make all payments payable to: Office of Alcohol and Tobacco Control; Cash is only accepted at the Baton Rouge Office. The cashier's window is open during the hours of 8:00 a.m. through 4:00 p.m., Monday through Friday, excluding holidays; Mail fully-completed forms, all supporting documents, and proper fees to: Office of Alcohol and Tobacco Control 8585 Archives Ave., Suite 220 Baton Rouge, LA 70809 SWORN STATEMENT your Signature: Title: Print your Name: ______________________________________________________ Sworn to and subscribed before in the Parish of day of State of ,20 _________________________________ _______________________________ Signature: NOTARY PUBLIC print name of notary public: FOR OFFICE USE ONLY Poster Serial # ____________________ Date Issued ____________________ Receipt # ____________________ Issued by ____________________ Poster Serial # ____________________ Date Issued ____________________ Receipt # ____________________ Issued by ____________________ Poster Serial # ____________________ Date Issued ____________________ Receipt # ____________________ Issued by ____________________ American LegalNet, Inc. www.FormsWorkFlow.com
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