Fillable CITY OF DECATUR, ILLINOIS CITY CLERKS OFFICE ONE (City of Decatur Illinois)

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CITY OF DECATUR, ILLINOIS CITY CLERKS OFFICE ONE (City of Decatur Illinois)

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CITY OF DECATUR, ILLINOIS
CITY CLERK’S OFFICE
ONE GARY K. ANDERSON PLAZA, SECOND FLOOR
DECATUR, ILLINOIS 62523
PH. 217.424.2708 Fax 217.450.2297
TEMPORARY LIQUOR LICENSE APPLICATION
NAME OF AGENCY REQUESTING TEMPORARY LIQUOR LICENSE:
AGENCY’S LOCAL BUSINESS ADDRESS:
AGENCY PHONE NUMBER:
CONTACT NAME:
CONTACT’S EMAIL ADDRESS:
EVENT NAME:
EVENT ADDRESS/LOCATION:
EVENT DATE(S):
ESTABLISHMENT PROVIDING ALCOHOL:
HOURS OF CONSUMPTION OF ALCOHOL:
COPY OF NOT-FOR-PROFIT REGISTRATION FILED WITH THE STATE OF ILLINOIS AND A
CERTIFICATE OF LIABILITY INSURANCE FOR SAID EVENT MUST ACCOMPANY SAID
APPLICATION.
AFFIDAVIT OF APPLICANT
ON OATH, I HEREBY STATE AND AVER, THAT:
1) The fa
cts asserted in the foregoing application for a temporary liquor license are true, on
information and belief.
2) I am duly authorized to and does sign this temporary liquor license application on behalf of said
not-for-profit agency, benevolent, or civic organization.
3) The not-for-profit agency, benevolent, or civic organization is duly organized and in good
standing with, and eligible to do business in the State of Illinois.
4) The not-for-profit agency, benevolent, or civic organization is not indebted to said State of Illinois
or City of Decatur, Illinois.
5) The not-for-profit agency, benevolent, or civic organization has not had its temporary liquor
license revoked for cause.
6) No law enforcing public official, Mayor or member of the City Council is interested in any way
directly in the not-for-profit agency, benevolent, or civic organization to be licensed.
7) I am qualified, as required by law and ordinance, for issuance of a temporary liquor license.
IN ACCORDANCE WITH CHAPTER 52 of the City Code of Decatur, Illinois:
SECTION 7. LICENSE FEE. Payment of a fee shall accompany the request for a temporary
permit, in accordance with the following schedule:
1st permit / year - $100.00 per day
2nd permit / year - $150.00 per day
3rd permit / year - $200.00 per day
4th permit / year - $250.00 per day
5th permit / year - $250.00 per day
6th permit / year - $250.00 per day
In the event a license does not issue responsive to an application, the payment of the annual fee
accompanying the same shall be refunded, otherwise, there shall be no rebate or prorate of a fee once paid.
8. TEMPORARY PERMIT. The Local Liquor Control Commissioner may issue a temporary
permit for the sale of alcoholic liquors to be consumed only on the premises at a banquet, picnic, bazaar,
fair or similar private or public assembly where food or drink is sold, served or dispensed. Such
temporary permit shall be issued only to a club, society, fraternity, benevolent or civic organization not
for pecuniary profit, and shall be for a period of not more than three days. The maximum number of
temporary permits issued to the same entity in one calendar year shall not exceed six (6) and not more
than one temporary permit shall be granted to any one
organization in any one period of thirty (30)
days.
PRINT NAME: ___________________________________
SIGNATURE
(Signature must be notarized before returning form to the City Clerk’s office.)
TITLE
___________________________________
DATE
STATE OF ILLINOIS )
)SS
COUNTY OF MACON)
SUBSCRIBED AND SWORN TO BEFORE ME THIS ____ DAY OF _______________, ________
(SEAL) __________________________________
NOTARY PUBLIC
MARK THE BOX BELOW TO INDICATE HOW YOU WILL OBTAIN THE APPROVED
TEMPORARY LIQUOR LICENSE:
WILL PICK UP THE LIQUOR LICENSE AT THE CITY CLERK’S OFFICE AFTER NOTIFIED
THE LICENSE IS READY.
MAIL THE LIQUOR LICENSE TO THE ESTABLISHMENT BY U.S. MAIL.
DATE APPROVED:
LOCAL LIQUOR CONTROL COMMISSIONER
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CITY OF DECATUR, ILLINOIS CITY CLERKS OFFICE ONE (City of Decatur Illinois)

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Completed 15 February 2021

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