Form L-W (3/2021)
23. CHECK HERE IF NOT IN CITY LIMITS
I, the applicant, have confirmed I am not located in the city limits of any city and therefore no city certifications are required.
COMPLETE THE FOLLOWING CHECKLIST BEFORE SUBMITTING YOUR APPLICATION
Per Sec. 102.01, a tied house is defined as any overlapping ownership between those engaged in the alcoholic beverage industry at
different levels of the three-tier system. No person having an interest in a permit issued by TABC may secure or hold, directly or indirectly,
an ownership interest in a business on a different level.
All required forms have been completed.
I have reviewed all forms to ensure they are complete.
I have obtained all required local and state certifications (pages 3-6).
All application packets have been notarized.
Phone number and email address for contact person are up to date.
All additional documentation as required by the application packets is attached
If required, out of state criminal history checks are attached (PHS #7).
Certification of publication in local newspaper has been completed (page 7).
A copy of the newspaper publication is attached (page 7). Yes No N/A
If Applicant Is/Must Sign
Limited Liability Company
WARNING: Section 101.69 of the Texas Alcoholic Beverage Code states: “…a person who knowingly makes a false statement or false representation in
an application for a permit or license or in a statement, report, or other instrument to be filed with the Commission and required to be sworn commits an
offense punishable by imprisonment in the Texas Department of Criminal Justice for not less than 2 nor more than 10 years.”
BY SIGNING YOU ARE SWEARING TO ALL INFORMATION AND ATTACHMENTS TO THIS PACKET.
Before me, the undersigned authority, on this day of , 20 , the
person whose name is signed to the foregoing application personally appeared and, duly sworn by me, states under oath
that he or she has read the said application and that all the facts therein set forth are true and correct.
S E A L
CERTIFICATE OF CITY SECRETARY FOR W, X, J, BB, BC & BI
Section 11.37 & 61.37
Not later than the 30
day after the date a prospective applicant for a license or permit requests certification, the city secretary or clerk shall certify
whether the location or address given in the request is in a wet area and whether the sale of alcoholic beverages for which the license or permit is sought
is prohibited by ordinance.
I hereby certify on this day of , 20 , that the location for which the license/permit is
sought is inside the boundaries of this city or town, in a “wet” area for such license/permit, and not prohibited by
charter or ordinance in reference to the sale of such alcoholic beverages.
I hereby refuse on this ______ day of _______________, 20____ to certify this location.
HERE , TEXAS
City Secretary/Clerk City
S E A L