Fillable Alcoholic Beverage App CITY OF BEAUMONT

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Alcoholic Beverage App CITY OF BEAUMONT

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BROWSE CITY OF BEAUMONT (TX) FORMS

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Adopted by the City of Beaumont 2014
CITY OF BEAUMONT
APPLICATION FOR ALCOHOLIC BEVERAGES PERMIT
Applicant: Applicant must submit all prescribe fees with completed applications.
Type of Permit(s) applied for:
___________________________________________________________________________
Application Date: _____ / _____ /_____
LEGAL OPERATOR(S) INFORMATION
Print full name(s) of legal operator(s):
______________________________________________________________________________
Last First Middle Initial Suffix Date of Birth Social Security No.
______________________________________________________________________________
Last First Middle Initial Suffix Date of Birth Social Security No.
______________________________________________________________________________
Last First Middle Initial Suffix Date of Birth Social Security No.
(If additional space is necessary use a separate sheet)
Hereby make application to operate doing business as:
______________________________________________________________________________
Name of Business Street Address Zip Code
______________________________________________________________________________
Operator’s Phone Number (24 hour access) Driver’s License or Identification Number Operator’s E-mail Address
Has this business ever operated under a different Trade Name:
Yes
No (Check One.) If yes, complete the following:
______________________________________________________________________________
Name of Business Previous Trade Name
Are you the legal owner of the property?
Yes
No (Check One.) If no, complete the following:
______________________________________________________________________________
Property Owner’s Name Street Address Zip Code
______________________________________________________________________________
Property Owner’s Phone Number Property Owner’s E-mail Address
Is this an existing business that is changing locations:
Yes
No (Check One.) If yes, complete the following:
____________________________________________________________________________________
Name of Business
____________________________________________________________________________________
Previous Address City State Zip Code
Primary Business:
___________________________________________________________________________________
Will your establishment have gaming machines? Yes No
Will your establishment have sexually oriented entertainment? Yes No
In full compliance with the ordinance provision of the City of Beaumont Code of Ordinances, Chapter 6 which regulates the conduct of such places,
I hereby certify that I fully understand and agree that such permit may be revoked in the event this facility is not operated in accordance with the
state law and local ordinance. I am applying for the alcoholic beverage permit and certify that all information submitted in this application is true
and correct. I understand that any false or misleading information shall cause my application to be denied; my permit revoked, and subjects me to
criminal prosecution.
Signature(s)____________________________________________________________________________
Applicant is an: Individual Partnership Corporation Association (Check One.) According to your answer, complete one of the following:
Federal Tax Identification Number: ____________________________________________________
A. INDIVIDUAL:
Business or residence address:
____________________________________________________
(P.O. Box will not be accepted)
Business or residence telephone: ___________________________________________________
B. PARTNERSHIP:
Names of Partners Business Address Telephone Number
(P.O. Box will not be accepted)
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
(If additional space is necessary use a separate sheet)
C. CORPORATION:
Organized under Texas Law Foreign Law (Check One.) According to your answer complete 1 or 2 below:
1) TEXAS CORPORATION:
Mailing Address
: _________________________________________________________
(P.O. Box will not be accepted)
Business Location: _________________________________________________________
Telephone No.: ____________________________________________________________
Individual in charge of Beaumont office: ___________________________________________
Names of Officers and Directors or Trustees:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
(If additional space is necessary use a separate sheet)
2) FOREIGN CORPORATION (Any Corporation not formed in Texas):
Mailing Address
: __________________________________________________________
(P.O. Box will not be accepted)
Business Location: _________________________________________________________
Telephone No.: ___________________________________________________________
Place of Incorporation:______________________________________________________
Individual in charge of Beaumont office: ___________________________________________
Names of Officers and Directors or Trustees:
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
(If additional space is necessary use a separate sheet)
D. ASSOCIATION:
Location (if multi state) of Principal Headquarters
: _______________________________________
(P.O. Box will not be accepted)
Mailing Address (if multi state) or Principal Headquarters: _________________________________
Principal Local Business Address:
__________________________________________________
Principal Local Mailing Address: ___________________________________________________
Principal Business Telephone Number: ______________________________________________
Names and principal business or residence address (P.O. Box will not be accepted) and telephone numbers of all members of the
association. (If the number exceeds 10, you may alternatively list the names and principal business address of the officers and
directors or trustees.
Names of Business Address Telephone Number
Members/Officers/Directors
(P.O. Box will not be accepted)
(Whichever applies)
___________________________________________________________________________
________________________________________________________________________
___________________________________________________________________________
(If additional space is necessary use a separate sheet)
MANAGER/OPERATOR INFORMATION
Print full names of manager/operator if different than owner:
____________________________________________________________________________________
Last First Middle Initial Suffix
____________________________________________________________________________________
Phone number (24 hour access) Driver’s License or Identification Number
____________________________________________________________________________________
Signature of manager/operator
____________________________________________________________________________________
Last First Middle Initial Suffix
_____________________________________________________________________________________________
Phone number (24 hour access) Driver’s License or Identification Number
___________________________________________________________________________________
Signature of manager/operator
____________________________________________________________________________________
Last First Middle Initial Suffix
____________________________________________________________________________________
Phone number (24 hour access) Driver’s License or Identification Number
____________________________________________________________________________________
Signature of manager/operator
(If additional space is necessary use a separate sheet)
BILLING INFORMATION
____________________________________________________________________________________
Contact Name
____________________________________________________________________________________
Billing Address City State Zip Code
____________________________________________________________________________________
Phone Number Email Address
CITY OF BEAUMONT USE ONLY
The applicant is in compliance with the ordinance for the following items:
Background Check
Copy of a Certificate of Occupancy issued by the city building official as appropriate for the proposed location.
Valid state permit.
Lease or rental agreement attached. (If applicable)
City Clerk Certification
APPROVED BY: ______________________________________________________________________________
Signature of Official Date Printed Name of Official
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Alcoholic Beverage App CITY OF BEAUMONT

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Completed 11 July 2020

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