Fillable INDIVIDUAL/SOLE PROPRIETOR APPLICATION FOR ALCOHOLIC LIQUOR (City of Decatur Illinois)

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INDIVIDUAL/SOLE PROPRIETOR APPLICATION FOR ALCOHOLIC LIQUOR (City of Decatur Illinois)

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______________________________________________________________________________________
CITY OF DECATUR, ILLINOIS
City Clerk
#1 Gary K. Anderson Plaza Decatur, IL 62523-1106
Phone: 217-424-2708
Fax: 217-450-2297
INDIVIDUAL/SOLE PROPRIETOR APPLICATION FOR ALCOHOLIC LIQUOR
LICENSE:
LICENSE EXPIRES: June 30, 2021 ANNUAL FEE: $2,200.00 - Class A, B, C, D, E, G, H, I, J, K, M, & O
ANNUAL FEE: $1,400.00 - Class N
ANNUAL FEE: $725.00 - Class F
ANNUAL FEE: $6,000.00 – Class P
PROCESSING FEE: $100.00 (New and/or Transfer)
RENEWAL LATE FEE: $100.00 + $20.00/day after July 31, 2020
CLASS OF LIQUOR LICENSE APPLIED FOR
______________
DESCRIPTION OF BUSINESS_____________________________________________________________
NAME OF BUSINESS ____________________________________________________________________
BUSINESS ADDRESS ___________________________________________ZIP CODE________________
TELEPHONE NUMBER __________________________________
EMAIL ADDRESS___________________________________
NAME OF OWNER/SOLE PROPRIETOR____________________________________________________
OWNER/SOLE PROPRIETOR HOME ADDRESS (INCLUDE CITY & ZIP CODE) _________________
(MUST RESIDE WITHIN DECATUR CITY LIMITS & PROVIDE COPY OF VALID ILLINOIS DRIVER’S
LICENSE OR STATE ID) Illinois Liquor Control Act of 1934, Sec. 5/6-2, Persons Ineligible to be Licensed: A
person who is not a resident of any City in which the premises covered by license are located.
OWNER’S/SOLE PROPRIETOR’S TELEPHONE NUMBER________________________
MANAGER OF LICENSED PREMISES:
NAME________________________________________________ DATE OF BIRTH__________________
HOME ADDRESS______________________________________________ZIP CODE_________________
(MUST RESIDE WITHIN DECATUR CITY LIMITS & PROVIDE COPY OF VALID ILLINOIS DRIVER’S
LICENSE OR STATE ID) Illinois Liquor Control Act of 1934, Sec. 5/6-2, Persons Ineligible to be Licensed: A
person who is not a resident of any City in which the premises covered by license are located.
TELEPHONE NUMBER___________________ EMAIL ADDRESS_______________________________
OWNER OF RECORD OF PREMISES TO BE LICENSED:
NAME_______________________________________
ADDRESS____________________________________________________ZIP CODE_______________
TELEPHONE NUMBER______________________________
AFFIDAVIT OF APPLICANT
ON OATH, I HEREBY STATE AND AVER, THAT:
1) The facts asserted in the foregoing application for a liquor license are true, on information and
belief.
2) I am the beneficial owner of the business to be operated under the liquor license applied for.
3) No law enforcing public official, Mayor or member of the City Council is interested in any way
directly or indirectly in the business to be licensed.
4) The manager’s affidavit of said business is attached.
5) I am qualified, as required by law and ordinance, for issuance of a liquor license.
6) I am a resident of the City of Decatur, Illinois.
7) I am not indebted to the State of Illinois or City of Decatur, Illinois.
8) I have not been convicted of a felony under any Federal or State law, convicted of keeping a place
of prostitution or keeping a place of juvenile prostitution, or convicted of pandering or other crime or
misdemeanor opposed to decency and morality, such that I am ineligible to receive a license under the
provisions of the Illinois Liquor Control Act of 1934, as amended.
9) I have not had a liquor license revoked for cause.
PRINT NAME _____________________________________
SIGNATURE______________________________________
Signature must be notarized before returning the form to the City Clerk.
TITLE ____________________________________________
DATE ____________________________________________
STATE OF ILLINOIS )
)SS
COUNTY OF MACON)
SUBSCRIBED AND SWORN TO BEFORE ME THIS ____ DAY OF _______________, ________
(SEAL) ________________________________________
NOTARY PUBLIC
LIQUOR LICENSE WILL BE MAILED TO THE ESTABLISHMENT
DATE APPROVED___________________________________
SIGNATURE OF LIQUOR COMMISSIONER_____________________________________
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INDIVIDUALSOLE PROPRIETOR APPLICATION FOR ALCOHOLIC LIQUOR (City of Decatur Illinois)

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Completed 15 February 2021

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