Fillable Beer And Wine License Application (Ben Hill County)

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Beer And Wine License Application (Ben Hill County)

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The Beer And Wine License Application (Ben Hill County) form is 3 pages long and contains:

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  • 17 check-boxes
  • 49 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Ben Hill County

BROWSE BEN HILL COUNTY (GA) FORMS

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Ben Hill County Georgia
Beer & Wine License Application
www.benhillcounty.com
Name of Business
Business Location Address
City, State, and Zip Code
Business Phone Number
Home Phone Number
Bus Location Map & Parcel
Location Manager(s)
Applicant's Name
Home Address
City, State, and Zip Code
If this is a Corparation please provide the following information
Corporation Name
Date Chartered
Business Mailing Address
City, State, and Zip Code
Type of Business
Applicant/Owner's Information
Email Address
Social Security Number
Date of Birth
Zoning Classification
Business Email Address
Is the Applicant an American Citizen or Alien lawfully admitted for permanent residency?
Please list the name(s) and other required information for each person having an interest in this business .
Name
Position
SSN #
Interest
Full Address
Name
Position
SSN #
Interest
Full Address
If more space is needed please use the back of this form.
Corporation
Partnership
Individual
Print Form
What type of business will you operate at this location?
Restaurant
Lounge
Convenience Store
Other (Describe)
License Information:
Retail Package Dealer
Beer
Wine
Consumption on Premises
Beer
Wine
Have you ever applied for an alcohol beverage license before? If so please give us the year of the application and its disposition:
If Yes give details
Are you familiar with Georgia and Ben Hill County Laws regarding the sale of alcoholic beverages?
Yes
Please Initial
Has any liqour business in which you hold, or have held, any financial interest, or are employed, or have been employed, ever been cited
for any violation of the rules and regulations of Ben Hill County or the State Revenue Commission relating to the sale and distribution of
distilled spirits?
Yes
No
Have you been arrested, or held by Federal, State, or other Law Enforcement Authorities for any violation of any Federal Law, State Law,
County or Municipal Law, Regulation or Ordinance? (Do not include traffic violations with the execption of any traffic offenses pertaining
to alcohol or drugs). All other charges must be included even if they are dismissed. Give reason charged or held, date, & place where
charged and its disposition
Yes
No
If this is a new application, state the straight line distance for the property line of the nearest School, Church, Library, or Public Recreation
Area to the wall of the building where alcoholic beverages are sold.
Church
School
Library
Public Recreation
State of Georgia , Ben Hill County, I
Do solemnly swear, subject to the penalties of false swearing, that the statements and answers made by me as the Applicant, I the
forgoing alcoholic beverage application are true.
Applicants Signature
If Yes please give full details
If Yes please give full details
List the Owner(s) of the building and property:
State the distance of the location of your business in miles to the City Limits of Fitzgerald:
I hereby certify that
is personally known to be, that he/she signed his/her name to the foregoing application stating to me that he/she knew and understood
all statements and answers made herein, and, under oath actually administered by me, has sworn that said statements and answers are
true.
This application has been reviewed and approved by the undersigned or their designee.
This
Day of
20
Notary Public
County Manager
Sheriff
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Beer And Wine License Application (Ben Hill County)

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Completed 17 July 2020

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