Fillable City of Gallatin Connie Kittrell (City of Gallatin)

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City of Gallatin Connie Kittrell (City of Gallatin)

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City of Gallatin Connie Kittrell
132 West Main Street Gallatin, TN 37066-3244 (615) 451-5895 w ww.gallatintn.gov
Special Event/Temporary Beer Permit Application
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 permit. 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.
Please complete the application and return to the City Recorder’s Office.
Please provide the following with the application:
$50.00 Non-Refundable Fee
Copy of Business License if Applicable
Copy of 501©3
Copy of Liability Insurance
Signed and Notarized Acknowledgement and Certification
City of Gallatin Connie Kittrell
132 West Main Street Gallatin, TN 37066-3244 (615) 451-5895 w ww.gallatintn.gov
Application for Special Event/Temporary Beer Permit
Special Event/Temporary Permit (Class IV) - $50.00
□ One Event Permit for Private Businesses
□ One Event Permit for Nonprofit Organizations
□ Multiple Event Permit for Nonprofit Organizations
Name of non-profit organization: _____________________________________________________________________________________
Event Name: ____________________________________________________________________________________________________________
Date of Event: __________________________________________ Hours of Event: _____________________________________________
Location of Event: ______________________________________________________________________________________________________
Event Contact Person: _________________________________________________________________________________________________
Telephone # of Contact Person: ______________________________________________________________________________________
Copy of 501©3: ________________________________________________________________________________________________________
Number of Events Requesting: ___________________
If requesting mulitiple event permits please provide event names, sponsors, locations, dates and hours:
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
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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
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
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Completed 4 August 2020

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