Fillable Ancillary Beer and Wine Tasting License Application (City of South Fulton)

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Ancillary Beer and Wine Tasting License Application (City of South Fulton)

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The Ancillary Beer and Wine Tasting License Application (City of South Fulton) form is 4 pages long and contains:

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  • 8 check-boxes
  • 48 other fields

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BROWSE CITY OF SOUTH FULTON (GA) FORMS

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Ancillary Beer and Wine Tasting License Application
City of South Fulton Alcoholic Beverage Licensee Information
Business Name
COSF Alcohol Beverage License #
Business Address with Suite/Unit
City
State
Zip Code
Licensee/Registered Agent Name
Licensee/Registered Agent Phone Number
Licensee/Registered Agent Email
Owner Name
Owner Phone Number
Owner Email
Type of Alcoholic Beverage License Held: (check all that apply). Ancillary License Fee $50
Malt Beverages Wine
City of South Fulton alcoholic beverage holder(s) with a package distilled spirits license cannot obtain an ancillary
tasting license.
Rules and Regulations
Eligibility to obtain an ancillary beer and wine tasting license:
Wine, beer and malt beverage sampling shall be on limited occasions when a customer requests a sample of a wine,
beer or malt beverage offered for sale within the premises, or in conjunction with education classes and sampling
designed to promote wine, beer and malt beverage appreciation and education.
Wine, beer or malt beverage tasting for customers shall be conducted only at a counter area constituting no more
than ten percent (10%) of the entire floor area of the premises.
Such sampling for customers shall be limited to no more than one (1) time per day, on the days of the week
authorized by the State law to sell beer and wine by the package for a period not to exceed two (2) consecutive hours.
Samples shall not exceed two (2) ounces, and no customer shall consume more than eight (8) ounces in any two-
hour period.
Wine, beer and malt beverage bottles shall be opened, and samples shall only be poured by an employee who
possesses a valid alcohol work permit.
No open containers of wine, beer or malt beverage shall be removed from the licensed premises.
The holder of an ancillary wine, beer and malt beverage tasting license may conduct educational classes and
sampling for classes not more than two (2) times per week for a period of not to exceed two (2) consecutive hours.
All conditions of sampling set forth in this section shall apply to such classes, except for the limitation on floor areas
where the classes can be conducted.
Holders of an ancillary wine, beer and malt beverage tasting permit shall not charge for samples or tastings, but may
accept donations for a charitable organization of their choice.
Such sampling and tasting are only permitted within the enclosed portion of the premises only.
The fee for an ancillary wine, beer and malt beverage tasting license shall be according to the fee schedule adopted
by City Council.
South Fulton Police Department
5539 Old National Highway
College Park, Georgia 30349
(470) 809-7372
The Following Must be Attached for Complete Submittal: (Check-Off)
☐ Completed Application
☐ Nonrefundable Application $150 and $50 Ancillary License fee.
☐ Alcohol Off Premises Event Permit Application (There is no additional application fee for this application)
☐ Citizenship Affidavit for Public Benefits and E-Verify Affidavit
☐ Copy of any advertisements for tasting
☐ Copy of State Issued Photo Identification
AFFIDAVIT
Georgia, Fulton County
I, (print name) under oath, do hereby solemnly swear that (a) I
have read and understand the requirements set forth above and otherwise provided pursuant to Title 16 of the Code of the
City of South Fulton, Georgia, in order to procure this license, and (b) the licensee and/or licensed premises presently meet all
of the requirements to be eligible to obtain this license. I further swear that the information I have provided herein or
otherwise to the City is true, and that I have made no knowingly false or fraudulent statement to the City in order to procure
the granting of this license. In making the foregoing representation under oath, I understand that any person who knowingly
and willfully makes a false, fictitious, or fraudulent statement or representation in this affidavit shall be guilty of a violation of
O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute.
Signature of Applicant
Subscribed and sworn to before me
This the day of , 20 .
(Signature of Clerk/Notary Public)
___________________________________________
Printed Notary Name
My commission expires:
For Office Use Only
Application Received by Investigator _____________________________________ Date Received _________________
Print Name Time Date Stamp
Application Meets all Requirements for License Application does NOT meet Requirements
Application APPROVED DENIED
____________________________________________________ ______________________
Chief of Police Signature Date
Edmunds Receipt Invoice #________________________ Ancillary License #:____________________________
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Save Affidavit
Affidavit Verifying Status for City Public Benefit
Pursuant to O.C.G.A. § 50-36-1(e)(2)
By executing this affidavit under oath, as an applicant for a(n) ____alcohol license_______________
[type of public benefit], as referenced in O.C.G.A. § 50-36-1, from City of South Fulton_ [name of government entity],
the undersigned applicant verifies one of the following with respect to my application for a public benefit:
1)
I am a United States citizen.
2)
I am a legal permanent resident of the United States.
3)
I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act
with an alien number issued by the Department of Homeland Security or other federal
immigration agency.
My alien number issued by the Department of Homeland Security or other federal
immigration agency is ____________________________.
The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least
one secure and verifiable document, as required by O.C.G.A.
§ 50-36-1(e)(1), with this affidavit.
The secure and verifiable document provided with this affidavit can best be classified as:
_____________________________________________________________________________.
In making the above representation under oath, I understand that any person who knowingly and willfully makes
a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of
O.C.G.A. § 16 -10-20, and face criminal penalties as allowed by such criminal statute.
Executed in ________________________________________ (city) ______________(state)
________________________________________ Signature of
Applicant
________________________________________ Printed Name
of Applicant
SUBSCRIBED AND SWORN BEFORE ME
ON THE
_____ DAY OF __________________, 20___
NOTARY PUBLIC
My Commission Expires:
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)
Page 4 of 4
E-Verify Affidavit
Private Employer Affidavit Pursuant to O.C.G.A. § 36-60-6(d)
By executing this affidavit under oath, the undersigned private employer verifies one of the following with respect to
its application for a business license, occupational tax certificate, or other document required to operate a business as
referenced in O.C.G.A. § 36-60-6(d):
Section 1.
Please check only one:
(A)
On January 1
st
of the below signed year, the individual, firm, or
corporation employed more than ten (10) employees.
(B) On January 1
st
of the below signed year, the individual, firm, or
corporation employed ten (10) or fewer employees.
*** If the employer selected Section1(A), please fill out Section 2 below.
Section 2.
The employer has registered with and utilizes the federal work authorization program in accordance with the
applicable provisions and deadlines established in O.C.G.A. §36-60-6. The undersigned private employer also
attests that its federal work authorization user identification number and date of authorization are as follows:
Name of Private Employer
Federal Work Authorization User Identification Number
Date of Authorization
------------------------------------------------------------------------------------------------------------------------
I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on this day ______ of
______________________, 20 in _________________________(city), ______(state).
Signature of Authorized Officer or Agent
Printed Name and Title of Authorized Officer or Agent
SUBSCRIBED AND SWORN BEFORE ME
ON THIS THE DAY OF , 20 .
NOTARY PUBLIC
My Commission Expires:
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Ancillary Beer and Wine Tasting License Application (City of South Fulton)

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Completed 2 August 2020

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