Fillable Beer Permit Application (City of Gallatin)

Fill Online, Printable, Fillable, Blank Beer Permit Application (City of Gallatin) Form

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

Beer Permit Application (City of Gallatin)

On average this form takes 17 minutes to complete

The Beer Permit Application (City of Gallatin) form is 9 pages long and contains:

  • 2 signatures
  • 13 check-boxes
  • 52 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Gallatin

BROWSE CITY OF GALLATIN (TN) 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
 
City of Gallatin Connie Kittrell
132 West Main Street Gallatin, TN 37066-3244 (615) 451-5895 w ww.gallatintn.gov
Beer Permit Application Process for
On-Premise, Off-Premise, Mixed On/Off-Premise &
Special Private Club License Applications.
The Gallatin Beer Board meets on the third Thursday of each month at 8:00 A.M. in the
Council Chambers located on the second floor of City Hall. The board requests that the
applicant or a representative be present at all meetings.
The City Recorder’s Office is responsible for all beer licenses located within the city limits of
Gallatin. The following instructions are provided to assist you with your request for a City of
Gallatin beer license. If you have questions please call 615-451-5895 for assistance.
Attached are the necessary forms for submitting an application for a beer permit in the City of
Gallatin.
Applications must be received by the Recorder’s Office fifteen (15) business days prior to the
regular monthly Beer Board Meeting.
Please complete the application and return to the City Recorder’s Office.
Please provide the following with the application:
$250.00 Non-Refundable Fee
Copy of City of Gallatin Business License if Applicable
Copy of Liability Insurance
Copy of Menu if Applicable
Signed and Notarized Acknowledgement and Certification
Alcohol and Beer Information
Signed and Notarized Affidavit
Signed Waiver
City of Gallatin Connie Kittrell
132 West Main Street Gallatin, TN 37066-3244 (615) 451-5895 w ww.gallatintn.gov
Application for Beer Permit
Application for (check one):
□ Off-Premises Permit (Class I) - $250.00
□ Package Retail Sales
□ Growler Sales
□ On-Premises Permit (Class II) - $250.00
□ Mixed Permit (Class III) - $250 each license
□ Special Private Club Permit (Class V) - $250.00
Date Received: ____________________________________ Fee Received: _____________________________________
I (we) hereby make application for a permit to sell, store, manufacture, or distribute beer or other
beverages authorized to be sold, stored, manufactured or distributed under the provisions of Tennessee
Code Annotated 57-5-101 et seq. and base my application upon the answers to the following questions:
1. Full name of applicant/business owner/organization: __________________________________________
□ Sole Proprietorship □ Partnership □ Limited Liability Corporation □ Corporation □ Other
2. List all persons, firms, corporations, joint-stock companies having at least a 5% ownership interest in
the business: ________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
3. Applicants Social Security #:__________________ Date of Birth: _______________ Driver’s License #:________________
Home Telephone: ___________________________ Business Telephone: _________________________________
4. What is your present home address? _____________________________________________________________________________
5. Previous address(es) (within last 10 years): ______________________________________________________________________
6. Under what name will this business operate: _____________________________________________________________________
7. Location of business by street address or other geographical description and phone number of the
business: _____________________________________________________________________________________________________________
City of Gallatin Connie Kittrell
132 West Main Street Gallatin, TN 37066-3244 (615) 451-5895 w ww.gallatintn.gov
8. Specify the identity and address of the person to receive annual privilege tax notices and any other
communication from the City: _____________________________________________________________________________________
9. Give name and address of property owner, if other than business owner: ____________________________________
10. Will the permit be used to operate two or more restaurants or other businesses under the same permit
as permitted by Section 57-5-103(a)(4) within the same building? □ Yes □ No
If so, specify number _______________. List the names of the restaurants or other businesses and describe
their location (use additional sheet if necessary): ______________________________________________________________
___________________________________________________________________________________________________________________________
11. Give name, date of birth, and address of any manager other than the applicant: ____________________________
___________________________________________________________________________________________________________________________
12. Has any person having at least 5% ownership interest, any of the managers listed in question 11, or any
other employee of the business been convicted of any violation of the beer or alcoholic beverage laws
or any crime (other than minor traffic violations) within the last ten (10) years? □ Yes □ No
If so, give particulars of each charge, court, and date convicted: ______________________________________________
___________________________________________________________________________________________________________________________
13. Has this owner or the owner’s organization had a beer permit revoked, suspended, fined, or denied in
the State of Tennessee? □ Yes □ No If so, specify where, when and why: ____________________________
___________________________________________________________________________________________________________________________
14. Give the name, relationship to applicant (if applicable) and address of the former beer permit holder at
this location. _______________________________________________________________________________________________________
15. What is the name and address of the church (or other place of worship) and/or school nearest to your
business? ___________________________________________________________________________________________________________
(Effective 7/1/2015, T.C.A. 57-5-103(a) requires all applicants to be a citizen or lawful resident of the United States
for at least one year immediately preceding the date of applying for the permit. The City reserves the right to request
documentation of residency or citizenship during the review and approval process.)
City of Gallatin Connie Kittrell
132 West Main Street Gallatin, TN 37066-3244 (615) 451-5895 w ww.gallatintn.gov
ACKNOWLEDGMENT AND CERTIFICATION
Applicant hereby solemnly swears that each and every statement in the foregoing application is true and
correct; that the City of Gallatin Beer Board will be notified promptly if there is a change in circumstances
that effects the responses provided in this application; that (1) No sale shall be made to anyone under 21
years of age; (2) applicant is aware that a permit will not be issued or will be revoked if the business
location causes traffic congestion or interferes with public health, safety, and morals; (3) No person,
member of the identified business entity or associate having at least a five percent (5%) ownership
interest, or person employed by applicant has been convicted of any violation of the laws against
possession, sale, manufacturing, or transportation of beer or other alcoholic beverages or any crime
involving moral turpitude within the past ten (10) years.
Applicant certifies that he or she has received documentation of an adequate Privacy Act Statement when
the applicant submits fingerprints and associated personal information.
Applicant certifies he or she understands that if any statement herein is false, the applicant shall forfeit his
or her permit and shall not be eligible to receive any permit for period of ten (10) years, in accordance with
TCA §57-5-105(d).
______________________________________________ __________________________
Applicant Date
State of: ______________________
County of: ____________________
Sworn to and subscribed before me this the ___________ day of _____________________________, 20_________.
My Commission Expires: _______________________
______________________________________________
Notary Public
City of Gallatin Connie Kittrell
132 West Main Street Gallatin, TN 37066-3244 (615) 451-5895 w ww.gallatintn.gov
Alcohol and Beer Information
Name of Business: ___________________________________________________________________
Business Address: ___________________________________________________________________
Business Phone: __________________ Name of Applicant: ________________________________
Date of Birth: ___________________ Place of Birth: ____________________ Height: ___________
Weight: ________________ Sex: __________ Eye Color: ____________
Social Security #:__________________________Driver License #:___________________________
Residential Address: ______________________________ Residential Phone #: _______________
Previous Residential Address: ________________________________________________________
Previous Employment: _______________________________________________________________
Previous Employment Address: _______________________________________________________
Have You Ever Been Arrested? □ Yes □ No
If yes, please list Dates of Arrest, Charges, Location of Arrest and Disposition: ______________
____________________________________________________________________________________
I verify that the foregoing statements are true and accurate to the best of my knowledge
_________________________________ ______________________________
Signature of Applicant Date
Office Use Only
An investigation has been completed at the Gallatin Police Department
By: _____________________________________________________________________________
Date: ___________________________________________________________________________
Chief of Police: __________________________________________________________________
Comments: _____________________________________________________________________
click to sign
signature
click to edit
City of Gallatin Connie Kittrell
132 West Main Street Gallatin, TN 37066-3244 (615) 451-5895 w ww.gallatintn.gov
FOR USE BY CITY OF GALLATIN ONLY
Application is hereby: □ APPROVED □ DENIED
This the __________ day of _________________________________, 20_______.
____________________________ ____________________________________
Beer Board Member Beer Board Member
____________________________ ____________________________________
Beer Board Member Connie Kittrell, City Recorder
City of Gallatin Connie Kittrell
132 West Main Street Gallatin, TN 37066-3244 (615) 451-5895 w ww.gallatintn.gov
Affidavit
State of Tennessee
County of Sumner
Personally appeared __________________________________, and having been duly
sworn states that:
1. My name is _________________________________. I am over eighteen (18) years of
age and competent to testify, based on personal knowledge, to the matters set forth
herein.
2. I certify that I have read Chapter 3, Article III of the Gallatin Municipal Code which
governs the sale and consumption of beer within the City of Gallatin, Tennessee and
I acknowledge responsibility to strictly enforce its provisions in my establishment.
3. I agree to notify the Beer Board of any change in the address of the permit holder
within ten (10) days of said change.
4. I understand that I assume full responsibility for the compliance with all provisions
of the Beer Ordinance and any other pertinent laws or ordinances.
Further the Affiant Saith Not.
__________________________
Name of Permit Holder
Subscribed and sworn to before me by the person whose signature is affixed hereto this
the ________ day of ________________________, _______.
__________________________
Notary Public
My Commission Expires: _____________________________
City of Gallatin Connie Kittrell
132 West Main Street Gallatin, TN 37066-3244 (615) 451-5895 w ww.gallatintn.gov
Background Check – Fingerprinting
Pursuant to Tennessee Code Annotated, Section 57-5-103, the City of Gallatin Beer
Board requires a background check be performed before a Beer Permit may be apporoved.
The applicant is required to make arrangements for fingerprinting through the Tennessee
Bureau of Investigation. These fingerprints will be used to check the criminal history
records of the TBI/FBI.
Please visit www.identogo.com or call (855) 226-2937 to schedule your appointment.
ORI: TN920758Z
A local option for fingerprinting is the UPS Store located at 695 Nashville Pike.
If you have any questions please contact the Recorder’s Office.
City of Gallatin Connie Kittrell
132 West Main Street Gallatin, TN 37066-3244 (615) 451-5895 w ww.gallatintn.gov
Waiver to Challenge Accuracy or Completeness of your
FBI Criminal History Record
If you decide to challenge the accuracy or completeness of your FBI criminal
history record, you should send your challenge to the agency that contributed
the questioned information to the FBI. Alternatively, you may send your
challenge directly to the FBI. The FBI will then forward your challenge to the
agency that contributed the questioned information and request the agency to
verify or correct the challenged entry. Upon receipt of an official communication
from that agency, the FBI will make any necessary changes/corrections to your
record in accordance with the information supplied by that agency.
(See 28 CFR 16.30 through 16.34.)
_________________________________ ____________________________________
Applicant Signature Date
click to sign
signature
click to edit
City of Gallatin Connie Kittrell
132 West Main Street Gallatin, TN 37066-3244 (615) 451-5895 w ww.gallatintn.gov
Privacy Act Statement
Authority: The FBI’s acquisition, preservation, and exchange of fingerprints and associated information
is generally authorized under 28 U.S.C. 534. Depending on the nature of your application,
supplemental authorities include Federal statues, State statues pursuant to Pub. L. 92-544, Presidential
Executive Orders, and federal. Providing your fingerprints and associated information is voluntary;
however, failure to do so may affect completion or approval of your application.
Social Security Account Number (SSAN). Your SSAN is needed to keep records accurate because
other people may have the same name and birth date. Pursuant to Federal Privacy Act of 1974 (5 USC
552a), the requesting agency is responsible for information you provide whether disclosure is
mandatory or voluntary, by what statutory or other authority your SSAN is solicited, and what uses
will be made of it. Executive Order 9397 also asks Federal agencies to use this number to help identify
individuals in agency records.
Principal Purpose: Certain determinations, such as employment, licensing, and security clearances,
may be predicted on fingerprint-based background checks. Your fingerprints and associated
information/biometrics may be provided to the employing, investigating, or otherwise responsible
agency, and/or the FBI for the p8urpose of comparing your fingerprints to other fingerprints in the
FBI’s Next Generation Identification (NGI) system or its successor systems (including civil, criminal,
and latent fingerprint repositories) or other available records of the employing, investigating, or
otherwise responsible agency. The FBI may retain your fingerprints and associated
information/biometrics in NGI after the completion of the application and, while retained, your
fingerprints may continue to be compared against other fingerprints submitted to or retained by NGI.
Routine Uses: During the processing of the application and for as long thereafter as your fingerprints
and associated information/biometrics are retained in NGI, your information may be disclosed
pursuant to your consent and may be disclosed without your consent as permitted by the Privacy Act
of 1974 and all applicable Routine Uses for the NGI system and the FBI’s Blanket Routine Uses. Routine
uses include, but are not limited to, disclosures to: employing, governmental or authorized non-
governmental agencies responsible for employment, contracting licensing, security clearances, and
other suitability determinations; local, state, tribal, or federal law enforcement agencies; criminal justice
agencies; and agencies responsible for national security or public safety.
Additional Information: The requesting agency and/or the agency conducting the application-
investigation will provide you additional information pertinent to the specific circumstances of
consequences of not providing requested information. In addition, any such agency in the Federal
Executive Branch has also published notice in the Federal Register describing any system(s) of records
in which that agency may also maintain your records, including the authorities, purposes, and routine
uses for the system(s).
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

Beer Permit Application (City of Gallatin)

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 4 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document