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This is a Vermont form that can be used for Department Of Liquor Control within Statewide.
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APPLICATION FOR THIRD CLASS LICENSE License Year: May 1st through April 30th the following year. Fee $1,095.00 $550.00 fee for establishment open for six continuous months or less of license year. Make check payable to and mail to: Vermont Department of Liquor Control 13 Green Mountain Drive Montpelier, Vermont 05602 Please check one: _______RESTAURANT______HOTEL______CLUB______COMMERCIAL CATERER License number____________________________ Licensee name of corporation/llc/person ________ __ ____ Doing Business as Trade Name Street Town or City & Zip Code Telephone Number ______________ ______________ _______________ ________ Mailing Address (if different from above) Email Address_____________________________ Application is hereby made for a third class license to sell spirituous beverages under and in accordance with Title 7 of the 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 regulations of the Liquor Control Board have been violated, or that any statement, information or answers herein contained are false. ALL APPLICANTS MUST COMPLETE AND SIGN I/We hereby certify that the information in this application is true and complete. Dated at State of Vermont, this in the County of day of and , 20 Signature of authorized agent of corporation, club or association, or individual Rev. 06/14/2016 American LegalNet, Inc. www.FormsWorkFlow.com