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License And Or Permit Application For Liquor County Malt Beverage Limited Winery Or Microbrewery WLD-031 - Wyoming
| License And Or Permit Application For Liquor County Malt Beverage Limited Winery Or Microbrewery Form. This is a Wyoming form and can be used in Wyoming Liquor Commission Statewide . |
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WLD-031 (10/11) FOR NEW LICENSES AND TRANSFER LICENSE AND/OR PERMIT APPLICATION FOR LIQUOR, COUNTY MALT BEVERAGE, LIMITED, WINERY OR MICROBREWERY To be completed by the City, Town or County Clerk: Date Filed: / / Annual Fee $ . $ . $ $ $ . . . Yes City Formerly Held by:__________________________________ Applicant: Basic Fee: Add'l Dispensing Room Fee: Transfer Fee: Total License Fee Collected Publishing Fee Collect: Prorated Fee $ . $ . Trade Name (dba): Premise Address: Number & Street $ . City State Zip County Mailing Address: Number & Street or P.O. Box Required Attachments Received: Advertising Dates(4): Hearing Date: Local Licensing Number: For the license term: Month State Zip / / Business Telephone Number: ( Fax Number: ( ) ) / Day / Year E-Mail Address: Through: Month / Day / Year A copy must be immediately forwarded to: State of Wyoming Liquor Division th 1520 E 5 Street Cheyenne WY 82002-0110 LICENSING AUTHORITY: Begin publishing promptly. As W.S. 12-4-104(d) specifies: NO LICENSING AUTHORITY SHALL APPROVE OR DENY THE APPLICATION UNTIL THE LIQUOR DIVISION HAS CERTIFIED THE APPLICATION IS COMPLETE. FILING FOR NEW TRANSFER LOCATION TRANSFER OWNERSHIP FILING IN (CHOOSE ONLY ONE) CITY OF COUNTY OF TYPE OF LICENSE OR PERMIT (CHOOSE ONLY ONE) RETAIL LIQUOR LICENSE on-premise only off-premise only combination on/off premise RESTAURANT LIQUOR LICENSE RESORT LIQUOR LICENSE COUNTY RETAIL or SPECIAL MALT BEVERAGE PERMIT VETERANS CLUB FRATERNAL CLUB GOLF CLUB SOCIAL CLUB MICROBREWERY WINERY BAR AND GRILL To Assist the Liquor Division with scheduling inspections: DO YOU OPERATE? FULL TIME (e.g. Jan through Dec) SEASONAL/PART-TIME (specify months of operation) from _____________ to _____________ DAYS OF WEEK (e.g. Mon through Sat) FILING AS (CHOOSE ONLY ONE) INDIVIDUAL LLC PARTNERSHIP LLP CORPORATION LTD PARTNERSHIP ASSOCIATION ORGANIZATION HOURS OF OPERATION (e.g. 10a - 2a) LOCATED WITHIN 5 MILES OF CITY (County License only) 1. Location of License: (a) Give a description of the dispensing room and state where it is located in the building (e.g. 10x12 room in SE corner of 1st floor of building). If the building is not in existence, provide the location and an architect's drawing or suitable plans of the room and premises to be licensed: If Winery or Microbrewery, also list manufacturing facility. W.S. 12-4-102(a)(i): (Please submit a drawing of dispensing room) (b) Do you have an additional dispensing room? YES NO If yes, provide description and location: (c) Provide the legal description and the zoning of the site where the applicant will conduct business: 2. Do you W.S. 12-4-103 (a) (iii): (1) OWN the building in which sales room is located? (2) LEASE the building in which sales room is located? YES (own) YES (lease) (A) DATE lease expires ________________ located on page_____paragraph_____of lease document. (B) Provision for SALE of alcoholic or malt beverages located on page_____paragraph_____of lease. NOTE: Attach a true copy of the lease to application. Lease MUST contain provision for SALE OF ALCOHOLIC or MALT BEVERAGES and be valid THROUGH the TERM OF THE LICENSE W.S. 12-4-103(a)(iii). 3. Have you already assigned, leased, transferred or do you intend to assign, lease, transfer, contract or in any other manner agree with any person or firm other than yourself as licensee to operate and assert control or partial control of the license and the licensed room to carry on the licensed liquor business? YES NO American LegalNet, Inc. www.FormsWorkFlow.com WLD-031 (10/11) 4. Does any manufacturer, brewer, rectifier, wholesaler, or through a subsidiary affiliate, officer, director or member of any such firm: W.S. 12-5-401, 12-5-402, 12-5-403 (a) Hold any interest in the license applied for? YES NO (b) Furnish by way of loan or any other money or financial assistance for purposes hereof in your business? YES NO (c) Furnish, give, rent or loan any equipment, fixtures, interior decorations or signs other than standard brewery or manufacturer's signs? YES NO (d) If you answered YES to any of the above, explain fully and submit any documents in connection therewith: 5. Does applicant have any interest or intent to acquire an interest in any other retail liquor license to be issued by this licensing authority? W.S. 12-4-103(b) YES NO If "YES", explain: 6. Is applicant a mayor, member of a city or town council, or member of the board of county commissioners within the jurisdiction of this licensing authority? W.S. 12-4-103(a)(i) YES NO 7. Is applicant employed by the State, City or Town, or County as a law enforcement officer, or hold office as a law enforcement officer through election? W.S. 12-4-103(a)(ii) YES NO RESTAURANT OR BAR AND GRILL LICENSE: Complete questions 8(a) and 8(b): 8. (a) Have you submitted a valid food service permit upon application? W.S. 12-4-407(a) W.S. 12-4-413(a) YES NO (b) Was your dispensing room for alcoholic and/or malt beverages in existence and open for consumption purposes prior to February 1, 1979? W.S. 12-4-410(b) YES NO N/A RESORT LICENSE: Complete questions 9(a) through 9(c): 9. (a) Is the actual valuation of the resort complex at least one million dollars, or have you committed or expended at least one million dollars ($1,000,000.00) on the complex, excluding the value of the land? W.S. 12-4-401(b)(i) YES NO (b) Does the resort complex include a restaurant and a convention facility which will seat at least one hundred (100) persons? W.S. 12-4-401(b)(ii) YES NO (c) Does the resort complex include motel or hotel accommodations with at least one hundred (100) sleeping rooms? W.S. 12-4-401(b)(iii) YES NO MICROBREWERY AND/OR WINERY LICENSE: Complete questions 10 through 11: 10. Is premise to be co-existent with a retail, restaurant, resort or bar and grill liquor license? W.S. 12-4-412(b)(iii) YES If "YES", please specify type: Microbrewery Restaurant Winery Resort Retail Bar & Grill: YES YES NO NO NO 11. (a) Do you self distribute your products? (b) Do you distribute your products through an existing malt beverage wholesaler? ORGANIZATION AND/OR CLUB LICENSE: Complete questions 12 through 15 as applicable: 12. FRATERNAL CLUBS W.S. 12-1-101(a)(iii)(B) (a) The name and address of the grand lodge or national organization is: (b) Does lodge or fraternal organization hold a charter from a national organization or national grand lodge? YES NO (c) Has the fraternal organization been actively operating in at least thirty-six (36) states? YES NO (d) Has the frate
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