Fillable Class B and C Application Supplemental Form (City of Portage)

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Class B and C Application Supplemental Form (City of Portage)

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Rev. 5/2019 Page 1 of 3
City of Portage Alcohol and Fermented Malt Beverage
Class B and C Application Supplemental Form
1. Applicant Information:
Applicant Name:
Trade name of business:
Business address:
Business Telephone Number:
Business email:
This application is a:
New application
Renewal application
This application is for a:
Class “B” (fermented malt beverage)
Class “B” (intoxicating liquor)
Class “C” (wine)
2. Business Plan
Describe the business; provide copy of business plan (business plan is for office use
only).
Describe your management experience.
Hours of Operation.
Number and type of employees expected to work at establishment.
Seating Capacity:
Anticipated opening date:
(new applicants only)
3. Explain your security plan, including presence and type of security surveillance,
including recording and store of surveillance video.
Rev. 5/2019 Page 2 of 3
4. Do you have a policy to train employees in the sale of alcohol? Yes No
If yes, how often is the policy review by the management and employees?
5. Explain your process for age verification of customers.
6. Attach a detailed site plan depicting the licensed premises, parking, garbage
storage area, entrances/exits, liquor storage areas, coolers, external lighting,
signage, etc.
7. Premises Description
Describe area where alcohol beverages are to be stored and indicate on site plan:
Describe area where alcohol records are to be stored and indicate on site plan:
Describe area where alcohol beverages are to be sold/served/consumed and indicate on
site plan:
If served in an outside area, include a complete description/location of that area and
indicate on site plan:
8. Is there currently a license at this location (new applicants only)?
Yes No
If yes, what, if any, changes are being proposed?
9. Will food be served on the premises? Yes No
If so, provide explanation of food preparation and serving areas, hours of operation,
types of food to be served on-site, pick-up and/or delivery, etc.
10. Is there any other business conducted on the premises? Yes No
If yes, please explain:
Rev. 5/2019 Page 3 of 3
11. Describe goods and services to be sold at this location, along with the estimated
% of sales devoted to alcohol, food, other products and services.
Percent gross receipts from intoxicating liquor and/or
fermented malt beverages
Percent gross receipts from food* *
Percent gross receipts from other
**If gross receipts from food are over 50% will you be serving food following closing
hours
If Yes, the following information must be included with the application
Financial Statements as prepared by an independent, 3
rd
party accountant,
auditor or bookkeeper demonstrating that greater than 50% of the gross
revenues for the prior 12 months were derived from the sale of food.
Security plan to lock up all alcohol (how alcohol will be secured and where
alcohol will be stored.) Submit site plan
12. Who may we contact between 8:00am and 4:30pm regarding this license?
Contact person
Email address
Telephone number
13. The following must be included with the application:
a. New Application
Federal Identification Number
Wisconsin Seller’s Permit or Use Tax Registration Certificate with expiration date
Wisconsin Department of Agriculture, Trade and Consumer Protection
Certificate with expiration date (if applicable)
Articles of Incorporation (Corporation/LLC only)
Deed, Lease or Offer to Purchase Agreement
Form for surrender of previous license (if applicable)
Responsible Beverage Service Training Course Certificate
b. Renewal Application-attach or check no changes box
Wisconsin Seller’s Permit or Use Tax Registration Certificate with expiration date
Wisconsin Department of Agriculture, Trade and Consumer Protection
Certificate with expiration date (if applicable)
Federal Identification Number no change from last application
Articles of Incorporation (Corporation/LLC only) no change from last application
Deed, Lease or Offer to Purchase Agreement – no change from last application
current year tax bill can be submitted in place of a deed
Form for surrender of previous license (if applicable)
Responsible Beverage Service Training Course Certificate –
submit only if change of agent
I certify the information provided on this form is true and correct to the best of my
knowledge
Signature
Date
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Class B and C Application Supplemental Form (City of Portage)

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Completed 19 January 2021

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