Connecticut > Statewide > Department Of Consumer Protection > Liquor Control Division
Application For Liquor Permit - Connecticut
| Application For Liquor Permit Form. This is a Connecticut form and can be used in Liquor Control Division Department Of Consumer Protection Statewide . |
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INSTRUCTIONS If OR FILING APPLICATION FOR LIQUOR PERMIT 1. Please read all questions carefully. All questions, including each separate part, must be answered. If a question or one of its parts does not apply, fill in the word "NONE". 2. FEE. The application must be accompanied by the proper permt fee and fiing fee in the form of a CERTIFIED PERSONAL OR CORPORATE CHECK. BANK CHECK. MONEY ORDER OR CASH (IF HAND CARED). A personal or corporate check which is NOT certified cannot be accepted under the statute. 3 . ATTACH EXTR sheets if space allowed under any item is inadequate or inconvenient. Write "see attachment" in any such space, and show name of permttee and date of application at the top of each sheet. Identify subject of attachment by letter and number as shown on this form (e.g. C, 2) for each such subject. 4. Please note the term "APPLICANT" as used in this application designates the person in whose name the permit wil be issued if the application is approved. It does not refer to backers of any kind. SECTION A Fil in type of permit desired (example: Restaurant Liquor, Restaurant Wine & Beer, Package Store, Grocery Beer, Cafe, etc. See permit fee schedule for complete list). Check appropriate box for patio. List type of1ive entertainment (be specific) Le., exotic dancers, comedians, bands, etc. SECTION B Fi\ in business telephone and trade name. Line 1. Fí1 in complete business address. Line 2. Fil in mailing address if different from line 1 address. Line 3. Check appropriate box and necessary permt information. Line 4. Fire Marshal's dated signature required for all on premises applications. Line 5. Must be completed by Zoning Offcial for all applications. Line 6. Must be completed by TownCity Clerk for all applications. SECTION C Fil in permittee's home phone number. Line 1. Fi\ in your last, first and middle names. Line 2. Fi\ in month, day, and year of your birth. SECTION D (For Manufacturers and Wholesalers only) Fill in permit number issued by A.T.F. and amount of bond posted with the Connecticut Department of Revenue Services. SECTION E Fill in Federal Employer Identification Number (F.E.LN.) issued by the Internal Revenue Service. SECTION F Check appropriate box for type of ownership. SECTION G Lines 1 through 4. Fil in name and date ofbiith for each individual owner or partner. SECTION H Line 1. Fil in name of corporation, unincorporated association, or limited liability company (LLC) Line 2. Fil in state of organization for entity listed in line 1. Line 3. Fil in date of organization (month, day, year). Line 4. If out-of-state entity, fill in date authorized to do business in Connecticut (month, day, year). birth (month, day, year). Line 5 & 6. Fil in name, number of shares he~ and date of SECTION I Fil in name and date of birth (month, day, year) for all general and limited partners. Include corporations if applicable and complete Section H. SECTION J Lines 1-3. Fil in all requested information for present or previous liquor permts held by any individual or corporation listed or by the immediate family member of any individual or corporate member listed. SECTION K Right to Occupy the prellses for which you are applying. If there is a percentage clause in the lease produce copy of lease. SECTION L THROUGH N Signatures and notarizations as required for type of ownership requested. American LegalNet, Inc. www.FormsWorkflow.com DOCUMENTS NEEDED FOR FILING APPLICATION FOR LIQUOR PERMIT o o o o D 1. SKETCH. A diagram, sketch, plan or blueprint of the layout of the premises, including patios, maximum 17"x 21" in size showing all dimensions e.g., height of separations, outside measurements of bars, measurement of doorways separating the barroom from the other rooms, etc. and all rooms labeled, e.g., dining room, Iockable storage area, barroom etc., for all applications except for grocery beer, airline, boat, railroad, out-of-state shippers, uúlitary, brokers and warehouse pennts. If your proposed preuúses has access to other areas withi the building, provide us with a separate the building labeling the other areas. the layout of diagram, sketch, plan or blueprint of 2. HEALTH CERTIFICATE.** All on preuúses locations. Signatures must be less than 60 days old at time of receipt by the Liquor Division. 3. SALES TAX NUMBER. Copy of receipt, stamp, letter or blue card required as proof. 4. PERSONAL HISTORY AND INFORMATION RELEASE AUTHORIZATION.** The applicant/pennttee and backers (individuals, parters, general parter and liuúted parters in a L TD partership, offcers, directors and a LLC manager and members in a LLC, corporate offcers and stockholders) must complete a personal history affdavit and an informtion release authorization affdavit. 5. CORPORATION. LLC AND LTD INFORMATION RELEASE AUTHORIZATION.** Only authorized individuals may sign on behalf of the above listed entities. o 6. FINANCES.** A completed Liquor Division financial affdavit. Additional documents may be required. CORPORATIONS & L.L.C. The application wil not be approved until the incorporation or organization papers have been fied with the Secretary of the State. Corporation papers may be transferred from an existing fie, if applicable. This means the following are required: o o A. Certificate of incorporation and proof of filing (if incorporated within 1 year) or certificate of good standing (if incorporated more than 1 year). An information release authorization for corporations must be subuútted with the aforementioned corporate documents. ** o D 7. GROCERY SALES FIGURS. ** For grocery beer pernts. The 9 item "Breakdown of Sales" form should be completed for a one month period. Estimates are not acceptable. Do not round off figures. Includes gas sales under #9. 8. FEDERA BASIC PERMIT. All wholesale and manufacturer pernts require a copy of the federal basic pernt issued by the Bureau of Alcohol, Tobacco & Firearm. 9. TAX BOND. All wholesale, warehouse and manufacture pernts require proof been posted with the Departent of o that a tax bond has Revenue Services. CLUB PERMITS. b. Copy of a. Copy of Charter Incorporation by-laws c. Proof of the existence of the club as a bonafide organization for at least three years in this state or proof that the club is a bonafide national or international fraternal or social organization in existence for at least one year in this state (e.g.: miutes). o 10. PHOTOGRAHS. 8"x 10" in size (any photos smaller than this required size wil not be acceptable). o o o o o A. O
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