Oklahoma > Statewide > Alcoholic Beverage Laws Enforcement Commission
Alcoholic Beverage Manufacturers Agent Employee And Charity Games Application LIC-017 - Oklahoma
| Alcoholic Beverage Manufacturers Agent Employee And Charity Games Application Form. This is a Oklahoma form and can be used in Alcoholic Beverage Laws Enforcement Commission Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
DO NOT REDUCE OR ENLARGE THIS FORM FOR ABLE USE ONLY CrC MO BkC Amount INITIALS ABLE CONTROL NUMBER CCk Cash NEW LICENSE NUMBER OKLAHOMA ALCOHOLIC BEVERAGE LAWS ENFORCEMENT COMMISSION ALCOHOLIC BEVERAGE MANUFACTURERS AGENT/AGENT/EMPLOYEE AND CHARITY GAMES EMPLOYEE/MANAGER APPLICATION FORM LICENSE NUMBER ______________ (Check One) NEW APPLICATION _________ RENEWAL APPLICATION _________ EXPIRATION DATE ______________ (Check One License Type; A separate application is required for each license type) Charity Games Manager ($50.00) Charity Games Employee ($15.00) Alchol. Bev Employee ($30.00) Alchol. Bev Agent ($55.00) Alchol. Bev Mfr Agent ($55.00) PLEASE TYPE OR PRINT NAME First Name Other Name (if any) Home or Mailing Address City Date of Birth Phone Number (Home) Drivers License Number Number Employer (if any) State Age State Sex M F (Check one) Middle Name Last Name NOT EMPLOYER ADDRESS Zip Code Social Security Number (Work) Street Address City State Zip ANSWER EACH OF THE FOLLOWING QUESTIONS. EACH YES ANSWER REQUIRES AN EXPLANATION. 1. Have you ever been convicted of or pled guilty or nolo contendere to any Felony? If YES, for what, where (city, county and state), and when convicted. YES ________ NO _________ 2. Have you ever been convicted of or pled guilty or nolo contendere of a misdemeanor related to gambling or YES gaming? If "YES", for what, where (city, county, and state) and when convicted. 3. Are you employed as: ________ NO _________ a) a judge, district attorney, or public official who sits in a judicial capacity with YES ________ NO _________ YES ________ NO _________ YES ________ NO _________ jurisdiction over the Oklahoma Alcoholic Beverage Control Act? b) a peace officer engaging in law enforcement activities? c) a Tax Commission employee engaging in auditing, enforcing, or collecting of alcoholic beverage taxes? If you answered YES to any of the above, where do you work and what do you do? Applicant Signature Line _________________________________________________________________ * Required Fields * Card Type VISA________ CREDIT CARD PAYMENT INFORMATION MASTER CARD________ DISCOVER______ AMERICAN EXPRESS______ * Name (as shown on card) _____________________________________________________________________ * Billing Address for Cardholder ___________________________________________________ * Home Phone Nr ________________ * Credit Card Number ________________________________ * Credit Card Expiration Date ___________ * CCSecurity Code __________ Card Holder * Signature Line _________________________________________________________________________________ Walk-in applications are accepted Monday thru Friday from 7:30 a.m. to 4:30 p.m. The license fee may be paid in cash, cashiers check, money order or credit card (Visa, Discover, MasterCard, American Express). PERSONAL CHECKS ARE NOT ACCEPTED. Walk in applicants submitting an application will receive a computer generated receipt that will serve as a license for a period not to exceed thirty (30) days. Applications may be mailed by CERTIFIED MAIL to: ABLE Commission, 4545 N. Lincoln, Suite 270, Oklahoma City, OK 73105. Be certain to include the license fee in one of the acceptable forms listed above. It is strongly recommended that you do not send cash through the mail. For those applying by certified mail the certified mail receipt and proper identification will serve as a license for a period not to exceed thirty (30) days. Be certain that you answer every question and provide the required explanations. Be certain that the application is legible. Applications that are illegible, incomplete, not accompanied by the required fee, or found to be inaccurate will be denied. For Alcoholic Beverage Employee License Applicants ** If you do not receive the new license at the listed address in thirty (30) days, contact the Licensing Division at (405) 521-3484. ** If a health card is required in your county, it is your responsibility to obtain one. ABLE Form Lic-017 Revised 12/2006 DO NOT SUBMIT EARLIER VERSIONS OF THIS FORM American LegalNet, Inc. www.FormsWorkflow.com
|
|||||||
