Fillable Auxiliary Questionnaire Alcohol Beverage License Application (Village of Mount Pleasant)

Fill Online, Printable, Fillable, Blank Auxiliary Questionnaire Alcohol Beverage License Application (Village of Mount Pleasant) Form

Use Fill to complete blank online VILLAGE OF MOUNT PLEASANT (WI) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Auxiliary Questionnaire Alcohol Beverage License Application (Village of Mount Pleasant)

On average this form takes 10 minutes to complete

The Auxiliary Questionnaire Alcohol Beverage License Application (Village of Mount Pleasant) form is 1 page long and contains:

  • 0 signatures
  • 0 check-boxes
  • 40 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Village of Mount Pleasant

BROWSE VILLAGE OF MOUNT PLEASANT (WI) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Auxiliary Questionnaire
Alcohol Beverage License Application
AT-103 (R. 7-18) Wisconsin Department of Revenue
Submit to municipal clerk.
(Signature of Named Individual)
Home Phone Number Age Date of Birth Place of Birth
Home Address (street/route) PostOce City State ZipCode
Individual's Full Name (please print) (last name) (rst name) (middle name)
The above named individual provides the following information as a person who is (check one):
Applyingforanalcoholbeveragelicenseasanindividual.
A member of a partnership which is making application for an alcohol beverage license.
of
which is making application for an alcohol beverage license.
The above named individualprovidesthefollowinginformationtothelicensingauthority:
1. HowlonghaveyoucontinuouslyresidedinWisconsinpriortothisdate?
2. Haveyoueverbeenconvictedofanyoenses(otherthantracunrelatedtoalcoholbeverages)for
violationofanyfederallaws,anyWisconsinlaws,anylawsofanyotherstatesorordinancesofanycounty
ormunicipality? ............................................................................. Yes No
Ifyes,givelaworordinanceviolated,trialcourt,trialdateandpenaltyimposed,and/ordate,descriptionand
status of charges pending.
(If more room is needed, continue on reverse side of this form.)
3. Arechargesforanyoensespresentlypendingagainstyou(otherthantracunrelatedtoalcoholbeverages)
forviolationofanyfederallaws,anyWisconsinlaws,anylawsofotherstatesorordinancesofanycountyor
municipality? ............................................................................... Yes No
Ifyes,describestatusofchargespending.
4. Doyouhold,areyoumakingapplicationfororareyouanocer,directororagentofacorporation/nonprot
organizationormember/manager/agentofalimitedliabilitycompanyholdingorapplyingforanyotheralcohol
beveragelicenseorpermit? ................................................................... Yes No
Ifyes,identify.
5. Doyouholdand/orareyouanocer,director,stockholder,agentoremployeofanypersonorcorporationor
member/manager/agentofalimitedliabilitycompanyholdingorapplyingforawholesalebeerpermit,
brewery/winerypermitorwholesaleliquor,manufacturerorrectierpermitintheStateofWisconsin? .......... Yes No
Ifyes,identify.
(Name, Location and Type of License/Permit)
(Officer / Director / Member / Manager / Agent) (Name of Corporation, Limited Liability Company or Nonprofit Organization)
(Name of Wholesale Licensee or Permittee) (Address By City and County)
6. Namedindividualmustlistinchronologicalorderlasttwoemployers.
Employer'sName Employer'sAddress EmployedFrom To
Employer'sName Employer'sAddress EmployedFrom To
READ CAREFULLY BEFORE SIGNING:Underpenaltyprovidedbylaw,theundersignedstatesthateachoftheabovequestionshas
beentruthfullyansweredtothebestoftheknowledgeofthesigner.Thesigneragreesthathe/sheisthepersonnamedintheforegoing
application;thattheapplicanthasreadandmadeacompleteanswertoeachquestion,andthattheanswersineachinstancearetrueand
correct.TheundersignedfurtherunderstandsthatanylicenseissuedcontrarytoChapter125oftheWisconsinStatutesshallbevoid,and
underpenaltyofstatelaw,theapplicantmaybeprosecutedforsubmittingfalsestatementsandadavitsinconnectionwiththisapplica-
tion.Anypersonwhoknowinglyprovidesmateriallyfalseinformationonthisapplicationmayberequiredtoforfeitnotmorethan$1,000.
Tab to navigate within form. Use mouse to check
appropriate boxes, press spacebar or press enter.
Save
Print
Clear
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Auxiliary Questionnaire Alcohol Beverage License Application (Village of Mount Pleasant)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 14 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document