Fillable Beverage-license City of Johns Creek

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Beverage-license City of Johns Creek

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BROWSE CITY OF JOHNS CREEK (GA) FORMS

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1
www.johnscreekga.gov
678-512-3200 ~ (fax) 678-512-3245
11360 Lakefield Drive, Johns Creek, GA 30097
ALCOHOLIC BEVERAGE LICENSE APPLICATION
INSTRUCTIONS: PLEASE PRINT OR TYPE APPLICATION AND ANSWER ALL QUESTIONS.
Please fill out entire application leaving no sections blank; please mark sections that do not apply N/A.
TYPE OF LICENSE: (Check appropriate spaces)
NEW ( ) ( ) RETAIL/PACKAGE ( ) Malt Beverage
CHANGE OF OWNERSHIP ( ) ( ) CONSUMPTION ON THE PREMISES ( ) Wine
( ) WHOLESALER ( ) Distilled Spirits
( ) Brew Pub/Brewery (on premise)
(must submit wholesale excise)
a. Restaurant ( ) b. Bar or Lounge ( ) c. Liquor Store ( )
d. Private ( ) e. Food Store ( ) f. Service Station ( )
g. Hotel/Motel ( ) h. Sunday Sales ( ) i. Other ( )
Specify:
1. Full Name of Business
Under what name is the Business to be operated?
Is the business a proprietorship, partnership or corporation? Domestic or foreign?
2. Address: a) Physical:
b) Mailing:
3. Phone Beginning Date of Business in City of Johns Creek
4. [ ] New business [ ] Existing business purchase
If change of ownership, effective date of this change
If change of ownership, enclose a copy of the sales contract and closing statement.
5. Federal Tax ID Number Georgia Sales Tax Number
6. Is business within the designated distance of any of the following:
CHURCH, SCHOOL GROUNDS, COLLEGE CAMPUS (See Land Survey Requirements)
YES NO
Beer and Wine 100 Yards ( ) ( )
Liquor 100 Yards (Church) or 200 Yards (School) ( ) ( )
Staff Use Only:
Amount Due: $____________________ Balance Due: $__________________ Staff Initials: ______________
Amount Paid: $____________________ Receipt #: _______________________
Staff Use Only
Control #:____________
License#: ____________
2
7. Full name of Applicant
Social Security Number Date of Birth
Full name of Spouse, if Married
Are you a Citizen of the United States or Alien Lawfully Admitted for Permanent Resident?
Birthplace
Current Address City St Zip
Home Telephone
Number of years at present address
Do you reside in Fulton County? If yes, how long?
Previous address
Number of years at previous address
Driver's License Number & State
What has been your occupation for the past five (5) years? Give detailed list (use additional page if necessary):
8. Applicant's employment date with present business
If new business, date business will begin in Johns Creek
If transfer or change of ownership, effective date of this change
If transfer or change of ownership, enclose a copy of the sales contract, closing statement, and check
here.
Previous Applicant
D/B/A
Any holder of any license under this chapter who shall for a period of three consecutive months after the
license has been issued cease to operate the business and sale of the product or products authorized shall, after
the three-month period, automatically forfeit the license without the necessity of any further action. Initial
here .
9. What is the name of the person who, if the license is granted, will be the active manager of the business and
on the job at the business? List address, occupation, phone number, and employer.
3
10. Has the applicant, spouse, or any individual having an interest either as owner, partner, or stockholder, been
arrested, convicted or entered a plea of nolo contendere within ten (10) years immediately prior to the filing
of this application for any felony or misdemeanor of any state or of the United States, or any municipal
ordinance except traffic violations? If yes, describe in detail and give dates.
11. Do you own the land and building on which this business is to be operated?
Date purchased Amount
If not, give amount paid for such land and building, the manner in which the rent is determined, to whom
and at what intervals it is paid. Give the name of the owner and agent, if any.
Attach a copy of the lease and any other pertinent documents.
12. How is the proposed location zoned?
13. Does this establishment have a patio/open area intended to be used for consumption of alcoholic beverages?
(check one) [ ] Yes or [ ] No
If yes, provide a site plan indicating the location of the patio in relation to the building, the height of
the fence and any entrances or exits. Reviewed by Zoning Administrator
14. If operating as a corporation, state name and address of corporation, when and where incorporated, and the
names and addresses of the officers and directors, social security numbers and the office held by each.
15. If operating as a corporation, list the stockholders (20% or more) complete addresses, area code and
telephone numbers, residential and business, and the amount of interest of each stockholder in the
corporation.
16. If operating as a partnership, list the partners with complete addresses, area code and telephone numbers,
residential and business, and the amount of interest or percent of ownership of each partner.
17. If partnership or individual, state names of any other persons or firms owning any interest or receiving any
funds from the corporation.
4
18. Does applicant or spouse received any financial aid or assistance from any manufacturer or wholesaler of
alcoholic beverages? If yes, please explain.
19. Does applicant or spouse any financial interest in any manufacturer or wholesaler of alcoholic beverages? If
yes, please explain.
20. List any and all persons, corporations, partnerships, or associations who have received or will receive, as a
result of your operations under the requested license, any financial gain or payment derived from any
interest or income from the operation. (Financial gain or payment shall include payment or gain from any
interest in the land, fixtures, building, stock, and any other asset of the proposed operation under the
license.) In the event that any corporation is listed as receiving and interest or income from this operation,
show the names of the officers and director of said corporation together with the names of the principal
stockholders.
21. State whether or not applicant, partner, corporation officer, or stockholder holds any alcoholic beverage
license in other jurisdiction or has ever applied for a license and been denied. (Submit full details)
22. Do you or your spouse or any of the other owners, partners, or stockholders have an interest in other liquor
stores? If so, state in how many stores each is interested and where stores are located. Explain fully. Attach
a list of all your brothers, sisters, children, grandchildren, father-in-law, mother-in-law, etc.
23. Are you or any member of your family the owner, lessor and/or sublessor of any real estate which is
occupied by a retail liquor store? If so, give the location information as to any lease or agreement, amounts
of rents, received to whom and whether rented or leased.
24. Are you or any member of your family the executor or administrator or beneficiary or heir of any estate
having any interest in a retail liquor store? If so, give the location, amount of interest, and your capacity with
the estate.
25. Are you or any member of your family the beneficiary or trustee of any trust fund having any interest in a
retail liquor store? If so, give your position, the name of the trust and the amount of income you receive.
5
26. Do you, your spouse, any partner or any stockholder have any financial interest in any wholesale liquor
business? If so give details.
27. Give the amount of gross sales of each of the retail liquor, beer, and wine stores at the above location for the
previous twelve (12) months and state the dates used in computing the gross sales. Indicate gross sales for
beer, wine and liquor separately.
Projected Annual Sales: Food Beer Wine Liquor
Total Sales
28. All beer, wine and liquor retailers shall only purchase alcoholic beverages from a State of Georgia Licensed
Wholesaler as per Georgia Alcoholic Beverage Laws and Regulations, 1996 Edition, as now or
hereafter amended, Chapter 560-2-2.04. Initial
29. Property Owner for Proposed Business Location
Address
City, State and Zip Telephone ( )
Name of Agent or Person Responsible
Address and Telephone
30. Real Estate Firm for Proposed Business Location
Address and Telephone
31. Property Management Company for Proposed Business Location
Address and Telephone
32. Do you have any questions or comments regarding the ordinances, laws, regulations or application?
( ) Yes ( ) No
33. Are you familiar with the City of Johns Creek ordinances, state laws and, regulations, federal laws and
regulations governing the operation of this type of business? ( ) Yes ( ) No
34. Have you made application for a State license? ( ) Yes ( ) No
35. Have you answered all questions? ( ) Yes ( ) No
6
Georgia, Fulton County
I, , being duly sworn to law, do swear that the statements made by me
in the above and foregoing answers to questions are true, and no false, or fraudulent statement is made herein and
such statements were made in order to procure the granting of such a license. I hereby authorize the City of Johns
Creek or its designated agent to obtain and review copies of any criminal and/or driver's histories in my name or
any alias used by me in the past or at the present. I understand that this information may be used against me
during the course of the City of Johns Creek’s investigation. I further certify that I will notify the City of Johns
Creek Office of the City Manager of any changes affecting my status and/or position with this company.
Print Name of Applicant
Signature of Applicant
Print Name and Title
Signature and Title of Person other than
Applicant Completing this Application
Phone Number Work
Home
Subscribed and sworn to before me
This _________ day of _______________, 20_____.
______________________________________ ____________________________________
(Clerk/Notary Public)
(Signature of Named Individual)
My commission expires: __________________
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7
www.johnscreekga.gov
678-512-3242 ~ (fax) 678-512-3245
11360 Lakefield Drive, Johns Creek, GA 30097
REGISTERED AGENT INFORMATION FORM
I, ______________________________________, do hereby consent to serve as the Registered Agent for the licensee,
owners, officers, and/or directors of and to perform all obligations of such agency under the Alcoholic Beverage Ordinance
of the City of Johns Creek, Georgia. I understand the basic purpose is to have and continuously maintain a Registered
Agent upon, which any process, notice, or demand required or permitted by law or under said ordinance to be served upon
the licensee or owner may be served upon the licensee or owner may be served. I understand that the Registered Agent
must be a citizen of the United States of at least 21 years of age and a resident of Fulton County. I further certify that I will
notify the City of Johns Creek Office of the City Manager of any changes affecting my status and/or position with this
company.
Signature of Agent
Type or Print Name of Agent
Type or Print Agent’s Home Address
Type or Print City, State, and Zip Code
Type or Print Area Code and Telephone Number
Type or Print Date Moved into the Above Address
Type or Print Driver’s License Number
Type or Print Date of Birth
Subscribed and sworn to before me
This _________ day of _______________, 20_____.
______________________________________ ____________________________________
(Clerk/Notary Public) (Signature of Named Individual)
My commission expires: __________________
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8
www.johnscreekga.gov
678-512-3242 ~ (fax) 678-512-3245
11360 Lakefield Drive, Johns Creek, GA 30097
ALCOHOLIC BEVERAGES - HOURS SALES ARE ALLOWED
PACKAGE - BEER AND WINE
Monday through Saturday 8:00 a.m. - 11:45 p.m.
Sunday 12:30 p.m. - 11:30 p.m.
PACKAGE - LIQUOR
Monday through Saturday 8:00 a.m. - 11:45 p.m.
Sunday 12:30 p.m. - 11:30 p.m.
CONSUMPTION ON THE PREMISES – BEER, WINE AND LIQUOR
Eating Establishment ONLY – establishment which is licensed to sell alcoholic beverages and which
derives at least 50 percent (50%) of its total annual gross food and beverage sales from the sale of prepared
meals or food.
Monday 9:00 a.m. – 2:00 a.m.
Tuesday 9:00 a.m. – 2:00 a.m.
Wednesday 9:00 a.m. – 2:00 a.m.
Thursday 9:00 a.m. – 2:00 a.m.
Friday 9:00 a.m. – 2:00 a.m.
Saturday 9:00 a.m. – 2:00 a.m.
Sunday* 11:00 a.m. – 2:00 a.m.
* Sunday sales may ONLY be made after paying the Sunday sales fee and obtaining authorization from the City.
9
www.johnscreekga.gov
678-512-3242 ~ (fax) 678-512-3245
11360 Lakefield Drive, Johns Creek, GA 30097
FOOD SALES AND ALCOHOLIC BEVERAGE SALES AFFIDAVIT
NAME OF ESTABLISHMENT:
ADDRESS OF ESTABLISHMENT:
LICENSEE’S NAME BUSINESS LICENSE #:
I. FOOD SALES AND ALCOHOLIC BEVERAGE SALES. The projected information below can be provided from the financial
records of the above establishment on a calendar-year basis or such period during which the establishment has been open.
PERIOD FOR WHICH INFORMATION IS PROVIDED:
(New businesses must provide a 12-month estimate)
Gross Receipts from Food Sales this period: $ ( %)
Gross Receipts from Alcoholic Beverage Sales this period: $ ( %)
Total Food Sales and Alcoholic Beverage Sales this period: $ ( %)
Briefly describe the method by which receipts will be segregated daily into food sales and alcoholic beverage sales:
____________________________________________________________________________________________________________
SUNDAY SALES AFFIDAVIT
II. I hereby affirm that I understand that the privilege of selling alcoholic beverages on Sundays from 12:30 p.m. until 2:00 a.m.
(Monday) requires a valid alcoholic beverage pouring license, valid Sunday Sales pouring license, and that at least 50% of the license
establishment’s annual gross food and alcoholic beverage sales must be derived from the sale of prepared meals and food.
I hereby affirm that I understand that records of food sales and alcoholic beverage sales must be prepared and maintained. Failure to
prepare and maintain records of food sales and alcoholic beverage sales is cause for denial or revocation of an alcoholic beverage
pouring license, including a Sunday Sales pouring license. I further affirm that I understand that the City of Johns Creek Revenue
division may audit our records to verify the same at its discretion.
Signature, Licensee/Owner
Sworn under oath this day of , 20 .
Clerk/Notary Public Signature
My commission expires: ____________________________
NOTARY SEAL
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10
www.johnscreekga.gov
678-512-3242 ~ (fax) 678-512-3245
11360 Lakefield Drive, Johns Creek, GA 30097
LAND SURVEY FOR ALCOHOLIC BEVERAGE LICENSE
For the purpose of the Alcoholic Beverage Ordinance, distance means the measurement in yards, from the front
entrance of the proposed location, to the main entrance of the church building or to the nearest portion of the school
grounds, along the nearest practical street route, measured as described in Article IV, Section 6 of the Alcoholic
Beverage Ordinance.
Per Article IV, Sec 6(e), unless otherwise provided by law, all measurements to determine the distances referred to
in this section shall be measured by the most direct route of travel on the ground and shall be measured in the
following manner:
1) In a straight line from the front door of the structure from which beverage alcohol is sold or offered for sale;
2) To the front door of the building of a church, government-owned treatment center or retail package store; or
3) To the nearest property line of the real property being used for school or educational purposes.
A scaled drawing of the location of the proposed premises, showing the distances described below, shall be
prepared by a Georgia Registered Land Surveyor. The following information shall be required on the survey:
1. Building location, shown in relation to the nearest road and nearest intersecting road(s).
2. Indicate location of main/front entrance of building used to determine appropriate distance requirements.
3. Name, address, telephone number of applicant.
4. Date of survey, graphic scale and north arrow.
5. Location of tract (land district and land lot).
6. Signature and certification statement(s) as listed below, on survey for related alcoholic beverage use.
7. Include one or both of the certification statements as listed below, on survey for related alcoholic beverage use:
Sales of DISTILLED SPIRITS is not located within 100 yards of a church building or
within 200 yards of any school building, school grounds, educational building, or college
campus, or within 100 yards of any alcoholic treatment center owned and operated by the
State of Georgia or any county or municipal government therein.
Sales of BEER and WINE is not located within 100 yards of any school building, school
grounds, or college campus, or within 100 yards of any alcoholic treatment center owned
and operated by the State of Georgia or any county or municipal government therein.
In my opinion, the premises meets the distance requirements listed above:
________________________________________________________________________________________________________
Surveyor Signature Registration Number Date
11
(Circle One)
City of Johns Creek Revenue Office 11360 Lakefield Drive, Johns Creek, GA 30097 (678) 512-3242
AUTHORIZATION FOR
BACKGROUND INVESTIGATION
(Alcoholic Beverage Licensee)
By signature below, I hereby authorize the City of Johns Creek and/or their designee, Business Consulting & Investigations, Inc. (BCI),
to conduct background research and retrieve information including, but not limited to, my previous criminal history, ownership / rental
records, location of residence and employment history.
_________________________ ___________________________ __________________________
Last Name First Name Middle Social Security Number
Have you ever used or are you known by any other names? (Including: maiden, married, alias, etc.) YES/NO
If yes, provide all full names used: ______________________________________________________
Employment information over the past ten (10) years: (If more space is needed, please attach on a separate sheet)
Employer Phone Number Supervisor
Dates of Employment Street Address City State Zip
Employer Phone Number Supervisor
Dates of Employment Street Address City State Zip
List all home addresses over the past ten (10) years: (If more space is needed, please attach on a separate sheet)
Current Street Address City State Zip Phone Number
Previous Street Address City State Zip Phone Number
____ __ _____________ ___/____/______ __________________________________________
Sex: M/F Race Date of Birth Driver’s License Number & State Issued Date of Birth Driver’s License Number & State Issued
Signature below also releases the City of Johns Creek and/or Business Consulting & Investigation, Inc. (BCI) and any
person or entity that provides information pursuant to this authorization, from any and all liabilities, claims or lawsuits in
regard to the information obtained from any and all of the above referenced sources used.
______________________________________ ______________________________
Applicant Signature Date
12
CITY OF JOHNS CREEK
ALCOHOLIC BEVERAGE LICENSE FEES
APPLICATION FEE: $ 1130.00
TYPE OF LICENSE: LICENSE FEE:
________CONSUMPTION ON THE PREMISES:
Wine $ 650.00
Malt Beverages $ 650.00
Distilled Spirit $3200.00
_________Additional Bar ______@ $1000.00 (Each)
_________Sunday Sales $250.00
_________Brewpub $500.00
_________Farm Winery Tasting $250.00
________ PACKAGE:
Wine $ 400.00
Malt Beverages $ 400.00
Distilled Spirits $3000.00
________WHOLESALE: Outside Within
CITY LIMITS CITY LIMITS
Wine $ 100.00 $500.00
Malt Beverages $ 100.00 $500.00
_________Distilled Spirits $ 100.00 $3500.00
TEMPORARY LICENSE ONLY LICENSE FEE:
________CONSUMPTION ON THE PREMISES:
________Wine and Malt Beverages $ 250.00
________Distilled Spirits $ 500.00
________PACKAGE:
________Wine and Malt Beverages $ 200.00
________Distilled Spirits No Temporary License Permitted
Ver 12-16-08
13
APPROVED ALCOHOL AWARENESS
TRAINING PROGRAMS
Training Institute for Responsible Vendors http://www.tirv.net/
TIPS http://gettips.com/
ServSafe http://www.servsafe.com/home
Evindi – RAS http://evindi.com/
Bloomin’ Brands http://bloominbrands.com/home/index.aspx
Learn2Serve http://www.learn2serve.com/
Communicata Language Services LLC
Darden Restaurants Responsible Alcohol Service Training Online
Rules and Regulations
Chapter 6, “Sec. 6-21(c). – Alcohol awareness training certification.
c. Every applicant to whom a pouring permit is issued and every employee who dispenses, sells, serves,
takes orders or mixes beverages shall also complete an approved alcohol awareness training program
within 30 days of being issued a pouring permit or being employed.” Each establishment shall maintain
an updated list of employees who have completed an approved alcohol awareness training program along
with copies of each of the employee’s completion certificate, and shall produce said list and/or certificates
for inspection by the city upon request.
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Beverage-license City of Johns Creek

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Completed 13 July 2020

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