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F Permit Application DLC 4115 - Ohio
| F Permit Application Form. This is a Ohio form and can be used in Division Of Liquor Control Department Of Commerce Statewide . |
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OHIO DEPARTMENT OF COMMERCE, DIVISION OF LIQUOR CONTROL 6606 TUSSING ROAD REYNOLDSBURG, OHIO 43068-9005 Telephone No. (614) 387-7407 Fax No. (614) 644-6965 http://www.com.ohio.gov/liqr F PERMIT APPLICATION FILING FEE $40.00 Five-Day Privilege for Special Functions - Valid for the Sale of BEER ONLY, Until 1:00 a.m. APPLICATION MUST BE FILED AT LEAST THIRTY (30) DAYS PRIOR TO THE DATE OF FUNCTION ยง 4303.20 F permit. Permit F may be issued to an association of ten or more persons, a labor union, or a charitable organization, or to an employer of ten or more persons sponsoring a function for the employer's employees, to purchase from the holders of A-1 and B-1 permits and to sell beer for a period lasting not to exceed five days. No more than two such permits may be issued to the same applicant in any thirty-day period. The special function for which the permit is issued shall include a social, recreational, benevolent, charitable, fraternal, political, patriotic, or athletic purpose but shall not include any function the proceeds of which are for the profit or gain of any individual. The fee for this permit is forty dollars. CAREFULLY READ THE GENERAL INSTRUCTIONS FOR FILING AN F APPLICATION - ON PAGE 5 TYPE OR PRINT PLAINLY Full Name of Organization ALL QUESTIONS MUST BE ANSWERED Street Address Where Function Will Be Held (BE SPECIFIC - and make this address uniform on all documents submitted) Township (Only if outside city or village limits) City State Zip Code OHIO Mail and/or Fax Permit and Correspondence To: Name: State: Zip Code: Street Address: Phone #: Name: Phone #: Title: City: Fax #: County: Individual responsible for the compliance with Ohio's liquor laws in conjunction with the sale and consumption of alcoholic beverages: Date and Time Function Will Begin: Date and Time Function Will End: Date Function Begins: Time Function Begins: am pm Date Function Ends: Time Function Ends: am pm Please check what type of organization: Association of ten or more persons Charitable Organization Employer of ten or more persons sponsoring a function for his employees, except for a manufacturer or wholesale distributor of alcoholic beverages (not open to the public) Labor Union The Division of Liquor Control does not regulate or advise individuals regarding gambling in conjunction with the issuance of an F permit. Any question regarding gambling should be directed to the Ohio Attorney General's Office, Charitable Gaming Section, 150 East Gay Street, 23rd Floor, Columbus, OH 43215 at (614) 466-3181. ANSWER ALL QUESTIONS ON PAGE TWO FOR OFFICE USE ONLY Taxing District Permit Number Receipt # DLC 4115 Rev. 12-2011 American LegalNet, Inc. www.FormsWorkFlow.com Remarks: Reviewer Action: 1. What is the purpose of the function? ( Note: The proceeds of the function shall not be used for the profit or gain of any individuals) _____________________________________________________________________________________________ Will the applicant receive 100% of the proceeds of the function? If NO, please explain: ________________________________________________________________________________________________________ (NOTE: The proceeds of the function shall not be used for the profit or gain of any individuals). YES NO 2. 3. Will any individual or for profit association, corporation, or other legal entity receive any financial profit or gain from the event for which you are requesting the F permit? If YES, please explain, including identity and share of each person to receive profit or gain: ________________________________________________________________________________________________________ YES NO 4. Will the members of the applicant organization coordinate and operate the event and conduct the sale of alcoholic beverages? If NO, please submit a detailed explanation of the non member involvement and their financial compensation. YES NO 5. Will any for profit association, corporation, or other legal entity be involved in the event for which you are requesting the F permit? If YES, please explain: ___________________________________________________________________________________ _______________________________________________________________________________________________________ Give the name and address of the brewer or distributor from whom beer will be purchased. _____________________________________________________________________________________________ _____________________________________________________________________________________________ YES NO 6. The Division of Liquor Control does not regulate or advise individuals regarding gambling in conjunction with the issuance of an F permit. Any question regarding gambling should be directed to the Ohio Attorney General's Office, Charitable Gaming Section, 150 East Gay Street, 23rd Floor, Columbus, OH 43215 at (614) 466-3181. THE FOLLOWING MUST BE COMPLETED BY THE APPLICANT(S): STATE OF OHIO, __________________________________COUNTY, ss I/We _________________________________________________________being first duly sworn, according to law, depose and say that the statements and answers made in the foregoing application are true, and say that I/We are at least twenty-one years of age and the statements and answers made in the foregoing application are true. I hereby acknowledge that I/We are required by law to be responsible for any conduct that violates laws pertaining to the sale of alcoholic beverages. FALSIFICATION OF ANY OF THE INFORMATION ON THIS APPLICATION CAN RESULT IN THE DIVISION'S REFUSING TO ISSUE THIS PERMIT. _____________________________________________________ _____________________ (Signatures of Officer of Association, Lodge or Corporation) (Title) __________________________________________ (Print Name) ________________________________________________ ___________________________ _______ _________________ _____________________________ (Residence Address) (City) (State) (Zip Code) (Telephone Number) (This portion to be completed by Notary Public) Sworn to before me and subscribed in my presence this ______________day of _______________________________________. _____________________________________________________ (Notary Public) (Notary Expiration) _____________________________________________________ (Notary - Please Print Name and Affix Seal/Stamp) Page 2 FOR TTY USERS DIAL ORS 1-800-750-0750 American LegalNet, Inc. www.FormsWorkFlow.com DLC 4115 EOE/ADA SERVICE PROVIDER OHIO DEPARTMENT OF COMMERCE DIVISION OF LIQUOR CONTROL 6
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