Vermont > Statewide > Department Of Liquor Control
First And Second Class Liquor License Application - Vermont
| First And Second Class Liquor License Application Form. This is a Vermont form and can be used in Department Of Liquor Control Statewide . |
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20 FIRST/SECOND CLASS LIQUOR LICENSE AND TOBACCO APPLICATION LICENSE YEAR IS MAY 1ST THROUGH APRIL 30TH OF THE FOLLOWING YEAR Print Full Name of Person, Partnership, Corporation, Club or LLC Doing Business As Trade Name Street and street number of premises covered by this application Town or City & Zip Code Telephone Number Mailing Address (if different from above) Email address__________________________________________________________________ Please circle appropriate categories FIRST CLASS SECOND CLASS TOBACCO FEES: FIRST CLASS LICENSE - $100.00 to DLC and $100.00 to Town/City SECOND CLASS LICENSE- $50.00 to DLC and $50.00 to Town/City TOBACCO ONLY LICENSE- $10.00 to Town/City only (there is no fee for tobacco if applying for second class) Restaurant Hotel Cabaret Club Commercial Kitchen (a Liquor Control Commercial Caterer's License is needed with this license) TO THE CONTROL COMMISSIONERS OF THE TOWN/CITY OF , VERMONT Application is hereby made for a license to sell malt and vinous beverages under and in accordance with Title 7, Vermont Statutes Annotated, as amended, and certify that all statements, information and answers to questions herein contained are true; and in consideration of such license being granted do promise and agree to comply with all local and state laws; and to comply with all regulations made and promulgated by the Liquor Control Board. Upon hearing, the Liquor Control Board may, in its discretion, suspend or revoke such license whenever it may determine that the law or any regulations of the Liquor Control Board have been violated, or that any statement, information or answers herein contained are false. MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING. If this premise was previously licensed, please indicate name I/we are applying as: INDIVIDUAL PARTNERSHIP LEGAL NAME (please circle one) LIMITED LIABILITY COMPANY CORPORATION STREET/CITY/STATE Please fill in name and address of individual, partners, directors or members. Are all of the above citizens of the UNITED STATES? ____Yes ____ No (Note: Resident Alien is not considered a U.S. Citizen) If naturalized citizen, please complete the following: __________________________________________________________________________________________ Name Court where naturalized (City/State/Zip) Date American LegalNet, Inc. www.FormsWorkFlow.com CORPORATE INFORMATION: If you have checked the box marked CORPORATION, please fill out this information for stockholders (attach sheet if necessary). LEGAL NAME STREET/CITY/STATE Date of incorporation Corporate Federal Identification Number Is corporate charter now valid? Have you registered your corporation and/or trade name with the Town/City Clerk? _______ and/or Secretary of State? ________ (as required by VSA Title 11 § 1621, 1623 & 1625). ALL APPLICANTS HAVE ANY OF THE APPLICANTS EVER BEEN CONVICTED OR PLED GUILTY TO ANY CRIMINAL OR MOTOR VEHICLE OFFENSE IN ANY COURT OF LAW (INCLUDING TRAFFIC TICKETS) AT ANY TIME? YES NO If yes, please complete the following information: (attached sheet if necessary) Name Court/Traffic Bureau Offense Date Do any of the applicants hold any elective or appointive state, county, city, village/town office in Vermont? (See VSA, T.7, Ch. 9, §223) complete the following information: Name Office Jurisdiction YES NO If yes, please Please give name, title and date attended of manager, director, partner or individual who has attended a Liquor Control Licensee Education Seminar, as required by Education Regulation No. 3: NAME: TITLE: DATE: (If you have not attended an Education Seminar prior to making application, please visit liquorcontrol.vermont.gov and click on Seminar Schedule for a list of Seminars in your area) FOR ALL APPLICANTS: DESCRIPTION /LOCATION OF PREMISES (Section 4) Description of the premises to be licensed: Does applicant own the premises described? If not owned, does applicant lease the premises? If leased, name and address of lessor who holds title to property: Are you making this application for the benefit of any other party? FIRST CLASS APPLICANTS ONLY: No first class license may be issued without the following information. HEALTH LICENSE #: Food Lodging (if licensed as a Hotel) VERMONT TAX DEPARTMENT: Meals & Rooms Certificate/Business Account # Business is devoted primarily to: (Circle one) FOOD (restaurant) ENTERTAINMENT (cabaret) HOTEL CLUB COMMERCIAL CATERING If you are considering Outside Consumption service on decks, porches, cabanas, etc. you must complete an Outside Consumption Permit. This form can be found on our website at liquorcontrol.vermont.gov and then click on licensing and then applications. CABARET APPLICANTS ONLY: Applicant hereby certifies that the sale of food shall be less in amount or volume than the sales of alcoholic beverages and the receipts from entertainment and dancing; if at any time this should not be the case, the applicant/licensee shall immediately notify the Department of Liquor Control of this fact. Signature of Individual, Partner, authorized agent of Corporation or LLC member ==================================================================================================================================== American LegalNet, Inc. www.FormsWorkFlow.com ALL APPLICANTS MUST COMPLETE AND SIGN BELOW The applicant(s) understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal repositories prior to acting on this application. I/We hereby certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, §3113). In accordance with 21 VSA, §1378 (b) I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. If applicant is applying as an individual: I hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or am in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, §795). Dated at this day of in the Coun
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