Fillable Liquor License 2017 - LIQUOR LICENSE

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Liquor License 2017 - LIQUOR LICENSE

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The Liquor License 2017 - LIQUOR LICENSE form is 6 pages long and contains:

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  • 11 check-boxes
  • 177 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Bensalem Township

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APPLICATION FOR INTER-MUNICIPAL TRANSFER OR
B. Corporate, Partnership and/or Other Applicant(s)
Corporate/Partnership/Entity Name:
Address:
City:
State: ZIP:
Phone No.:
Fax Number:
E-Mail Address:
State of incorporation and/or registration of the applicant:
Date of incorporation and/or registration of the applicant:
Date
ECONOMIC DEVELOPMENT LIQUOR LICENSE(S)
The following information is to be provided by the Applicant along with the completed application for an Economic
Development liquor license or for the transfer of a liquor license from outside Bensalem Township.
Please place a check in the box indicating completion of each task.
1.
A copy of the deed, the agreement of sale, and/or the lease for the subject property as applicable.
2.
A sketch plan of the property identifying the existing and proposed improvements.
3.
A plan of the interior of the building/facility identifying the locations and dimensions of the bar area,
restaurant area, kitchen, bathrooms, outdoor patron areas, and storage areas as applicable.
4.
A
floor plan identifying the proposed layout of the bar area, restaurant area, and/or outdoor patron areas
including, but not limited to, the location of the bar(s), tables, chairs, stools, dance floor(s), stage(s),
and/or any other areas to which the public will have access as applicable.
5.
Completed application form.
TYPE OF LICENSE FOR WHICH YOU ARE APPLYING
Inter-Municipal Transfer Economic Development License
LOCATION OF THE PROPERTY FOR WHICH THE LICENSE IS SOUGHT
Address:
Tax Parcel Number:
APPLICANT INFORMATION
If the applicant(s) is an individual (or individuals), complete Section A. If the applicant(s) is a corporation,
partnership and/or any entity other than an individual, complete Section B.
A. Individual Applicant(s)
Name:
Address:
City: State: ZIP:
Phone No.: Fax Number:
Type of Business:
Type of license for which you are applying:
E-Mail Address:
BENSALEM TOWNSHIP
Building and Planning Department
2400 Byberry Road ▪ Bensalem, PA 19020
Office 215-633-3644 ▪ Fax 215-633-3753
BENSALEM TOWNSHIP
PAGE 2 of 6
List the name, address. Telephone number, fax number and e-mail addresses of each and every owner.
Director, officer and equity owner of the Applicant(s) below:
Name Address Telephone No. Fax No. E-Mail Address
OWNER OF PROPERTY TO BE LICENSED (if not applicant)
If the Owner(s) of the subject property is an individual (or individuals), complete Section A. If the Owner(s)
of the subject property is a corporation, partnership and/or any entity other than an individual, complete Section B.
A. Individual Owner(s)
Name: Telephone No.:
Address: Fax No.:
City: State: Zip:
E-Mail Address:
B. Corporate, Partnership and/or Other Owner(s)
Corporate/Partnership/Entity Name:
Address:
City: State: Zip:
Telephone No.: Fax Number:
E-Mail Address:
State of incorporation and/or registration of Owner:
Date
Date of incorporation and/or registration of owner(s):
Name Address Telephone No: Fax No: E-Mail Address
APPLICANT’S OWNERSHIP INTERESTS IN THE PROPERTY
If the Owner of the property to be licensed is not the Applicant, describe the
Applicant’s interest in the subject property
BENSALEM TOWNSHIP
PAGE 3 of 6
APPLICANT AND/OR OWNER INTERESTS IN OTHER PROPERTIES
Please provide a list of all other properties and/or businesses owned and/or operated by the Applicant
and/or the owners, equity owners, directors and/or officers of the Applicant, that have, at any time, been
issued or held liquor licenses. For each such property or business, state the name, address, telephone
number, fax number, e-mail address and tax parcel number of each such property or business, together
with the liquor license number of each and every license issued to each such property, business owner,
equity owner, director, officer and/or the applicant.
Name:
Address:
City: State: Zip:
Telephone No: Fax Number:
E-Mail Address:
Liquor License No:
Name:
Address:
City: State: Zip:
Telephone No: Fax Number:
E-Mail Address:
Liquor License No:
Name:
Address:
City: State: Zip:
Telephone No: Fax Number:
E-Mail Address:
Liquor License No:
USE SEPARATE SHEET IF ADDITIONAL SPACE IS NEEDED
Has the Applicant and/or the owners, equity owners, directors and/or officers of the Applicant ever been
convicted of, and/or received citations for any violations of the Pennsylvania Liquor Code, the
Pennsylvania Controlled Substance, Drug, Devise & Cosmetic Act, and/or any provisions of the
Pennsylvania Criminal Code?
YES NO
If yes, identify to whom each such citation was issued and/or who was convicted, together with the date
and location at which the violation occurred, nature of the violation, the statute, ordinance or regulation
violated, court agency before which the violation was adjudicated, and the fine and/or punishment
imposed for each such citation and/or conviction.
Nature of Violation:
Statute:
Violation:
Court Agency:
Fine and/or Punishment:
BENSALEM TOWNSHIP
PAGE 4 of 6
ATTORNEY FOR THE APPLICANT
Attorney Name: Telephone No:
Address: Fax Number:
City: State: Zip:
E-Mail Address:
ATTORNEY FOR THE PROPERTY OWNER
Attorney Name: Telephone No:
Address: Fax Number:
City: State: Zip:
E-Mail Address:
TRANSFER INFORMATION
If this is an inter-municipal transfer of a liquor license, provide the requested information
for the location rom which the license is being transferred.
Address:
Municipality:
Tax Parcel Number:
INTENDED USE OF THE PROPERTY AND/OR FACILITY
Provide a statement of, and/or a description of, the intended use of the property and/or facility below.
Include the following information:
a. Hours of Operation
b. Whether live music or entertainment will be provided
c. Whether dancing will be permitted
d. Whether billiards, darts, video games and/or arcade games will be available
e.
Whether outside facilities, including but not limited to a bar area, restaurant area, and/or athletic and/or
entertainment areas will be provided. If yes, provide a description of such outdoor areas. If outdoor
entertainment or dancing is to be permitted, provide a description of the intended entertainment.
BENSALEM TOWNSHIP
PAGE 5 of 6
DESCRIPTION OF NEIGHBORING AND NEARBY PROPERTIES
BENSALEM TOWNSHIP
PAGE 6 of 6
CERTIFICATION
I do hereby certify that the information submitted in this
application is true and correct. I acknowledge that submission of false or inaccurate information may result in the
revocation of the liquor license by the Commonwealth and the rejection of the application and/or the rejection of
any and all approvals issued by Bensalem Township. I further acknowledge that the presentation of false
Information may result in possible arrest, fines and imprisonment.
Applicant’s Signature
Date
A SIGNED COPY OF THIS APPLICATION MUST BE SUBMITTED PRIOR TO ISSUANCE OF LICENSE
**************************************************************************************************************************
Approval Granted Approval Denied
Bensalem Township Council
Council Clerk Signature
Date
Rev 6/2016
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Liquor License 2017 - LIQUOR LICENSE

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Completed 11 July 2020

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