Business
License
1300 PERDIDO ST | SUITE 7W03 | NEW ORLEANS | LOUISIANA | 70112 | 504.658.7100 8
ALCOHOLIC BEVERAGE OUTLET INDIVIDUAL APPLICATION SUPPLEMENT A
3.
Do you or your spouse own or hold interest in any business holding an alcoholic beverage
manufacturer/supplier permit?
If YES, complete the following questions. If there is more than one business, attach a list
disclosing each.
Permit Number ___________________________
Trade Name______________________________
Location ________________________________
Yes
No
4.
Do you or your spouse own or hold interest in any business holding an alcoholic beverage
wholesale permit or solicitors permit?
If YES, complete the following questions. If there is more than one business, attach a list
disclosing each.
Permit Number ___________________________
Trade Name______________________________
Location ________________________________
Yes
No
5.
Is this application being submitted by you to obtain an alcoholic beverage permit in your name
for the benefit of any other person?
Yes
No
IF YOU ANSWER "YES" TO ANY OF THE FOLLOWING QUESTIONS ABOUT YOUR CRIMINAL
HISTORY, YOU (AND YOUR SPOUSE) MUST COMPLETE A SUPPLEMENT F
6.
Have you or your spouse ever been convicted of violating any state or local alcoholic beverage
regulatory statute, rule, or ordinance?
Yes
No
7.
Have you or your spouse had a license or permit to sell or deal in alcoholic beverages revoked
within the last (2) years prior to the filing of this Schedule A?
Yes
No
8.
Have you or your spouse ever been denied an alcoholic beverage permit?
Yes
No
9.
Have you or your spouse ever been convicted of a felony?
10.
(This includes an offense adjudicated under Article 893 or 894, dismissals, pardons,
expungements, guilty pleas, and pleas of nolo contendere "no contest.")
Yes
No
11.
Have you or your spouse ever been convicted of solicitation for prostitution, pandering, letting
premises for prostitution, contributing to the delinquency of a juvenile, keeping a disorderly
place, or dealing in controlled dangerous substances?
Yes
No
12.
Have you or your spouse ever been convicted of distributing or possessing with intent to
distribute any controlled dangerous substance classified in Schedule I of R.S.40:964 on any
premises holding an alcoholic beverage permit where you held or hold an ownership interest in
the Have you or your spouse been convicted or had a judgment of court rendered against you
involving the sale or service of alcoholic beverages by this or any other state, or by the U.S.
within the last (2) years?
Yes
No
13.
Have you or your spouse ever been convicted, in this or in any other state in the U.S., of theft?
Yes
No
14.
Have you or your spouse ever been convicted, in this or in any other state in the U.S., of any
crime involving false statements or declarations?
Yes
No
ACKNOWLEDGEMENT & AFFIDAVIT
STATE OF LOUISIANA, PARISH OF ORLEANS
Before me, the undersigned Notary Public, personally came and appeared__________________________________,
the appeared(s) in the above and foregoing instrument, who declared under oath to me, Notary,:
that he/she prepared and signs the above and foregoing Supplement A including the required attachments,
and that the instrument is tendered in support of the Occupational and Business License Master Application
for an alcoholic beverage permit made to the City of New Orleans by the business applicant stated herein,
that the signature appearing hereon is his/her own, of his/her own free and voluntary act and is for intent and
purposes therein expressed, and that he/she swears that the information given and all answers therein are
true and correct.