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F-2 Permit Application DLC 4138 - Ohio
| F-2 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, P.O. Box 4005, Reynoldsburg, Ohio 43068-9005 Telephone No. (614) 644-3155 - Fax No. (614) 644-6965 http://www.com.state.oh.us F-2 PERMIT APPLICATION Fee: $150.00; $160.00 if issued jointly with the holder of a D-3, D-4 or D-5 permit. An F2 permit may be issued to an association or corporation, or to a recognized subordinate lodge, chapter, or other local unit of an association or corporation organized not for profit and operated for a charitable, cultural, fraternal, or educational purpose to sell beer and intoxicating liquor until 1:00 a.m., at an event not to exceed forty eight consecutive hours. No more than two F2 permits may be issued to any applicant within a calendar year. APPLICATION SHOULD BE FILED THIRTY (30) DAYS PRIOR TO EVENT CAREFULLY READ THE GENERAL INSTRUCTIONS FOR FILING F-2 APPLICATION TYPE OR PRINT PLAINLY Name of Non-Profit Organization (Exact Name must be uniform on all documents) ALL QUESTIONS MUST BE ANSWERED Street Address (Where Function Will Be Held - BE SPECIFIC & must be uniform on all documents) Township (Only if Unincorporated Area) City State Zip Code County OHIO Mail and/or Fax Permit and Correspondence To: Name: State: Zip Code: Street Address: Phone: ( ) Fax: ( City: ) 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: Name: ________________________________________ Title: ____________________ Phone # ( ) _________________________________ Date and Time Function Will End: The Division of Liquor Control does not regulate or advise individuals regarding gambling in conjunction with the issuance of an F2 permit. Any question regarding gambling should be directed to the Ohio Attorney General's Office, Charitable Gaming Section, 101 East Town Street, Columbus, OH 43215 at (614) 466-3180. SECTION A 1. Has any officer of the applicant organization, or the organization itself ever been convicted of any felony or misdemeanor? If YES, attach a written explanation. 2. Will a D3, D4 or D5 permit holder be conducting the sale of alcoholic beverages? If YES, this application should be filed jointly. Please indicate below the permit holders name and permit number. Permit holder's name _______________________________________________________________________________ Permit number ____________________________________________________________________________________ FOR OFFICE USE ONLY Taxing District Permit Number Receipt # YES NO YES NO (Note: Both F2 applicant name and issued permit holder name must be on all documents where "Name of Non Profit Organization is requested) Reviewer Action: Remarks: DLC 4138 Rev. 1-07 American LegalNet, Inc. www.FormsWorkflow.com 3. Please check the specific purpose for which your organization operates: Charitable 4. Cultural Fraternal Educational 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) ___________________________________________________________________________ List and identify who will receive the proceeds of this function; list the distribution of those proceeds. ________________________________________________________________________________________________ 5. 6. Is applicant a not for profit association, corporation, or a recognized subordinate lodge, chapter, or other local unit of a not for profit association or corporation? 7. If requested, will the applicant provide to the Division of Liquor Control evidence from the Secretary of State's Office that the applicant is a valid not for profit association, corporation, or a recognized subordinate lodge, chapter, or other local unit of a not for profit association or corporation? If NO, please explain: ____________________________________________________________________________ 8. Is applicant affiliated with the holder of any class of liquor permit other than D-4? If YES, please explain: ____________________________________________________________________________ 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-2 permit? If YES, please explain, including identity and share of each person to receive profit or gain: _______________________ ________________________________________________________________________________________________ YES NO YES NO YES NO 9. YES NO 10. 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. 11. Will any for profit association, corporation, or other legal entity be involved in the event for which you are requesting the F-2 permit? If YES, please explain: _____________________________________________________________________________ ________________________________________________________________________________________________ YES NO YES NO THE FOLLOWING MUST BE COMPLETED BY THE APPLICANT(S): NOTE: ANY PERSON WHO KNOWINGLY MAKES A FALSE STATEMENT ON THIS APPLICATION OR STATEMENT IS GUILTY OF THE CRIME OF FALSIFICATION, A MISDEMEANOR OF THE FIRST DEGREE State of Ohio, ____________________________________________County, ss I/We ___________________________________________________, being first duly sworn, according to law, depose and say that I/We are at least twenty-one (21) years of age and the statements and answers made in the foregoing application are true. With respect to the F-2 permit, I/We agree to comply with all applicable statutes and rules. I/We 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, and that both parties are responsible for any violations of the other if the F-2 permit is issued jointly. I/We further depose and say the applicant would be the proper holder of the F-2 permit and that the F-2 permit holder will comply with all applicable statutes and administrative rules. ___________________________________________ (Signature and Title of Applicant) __________________________________________________ (Signature of D-3, D-4, or D-5 Permit Holder if to be issued jointly) Sworn to before me and subscribed in my presence this ________ day of _______________________
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