Fillable Liquor License Application

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Liquor License Application

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File type: PDF

U.S.A. forms for Village of Lincolnshire

BROWSE VILLAGE OF LINCOLNSHIRE (IL) FORMS

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1 Olde Half Day Road, Lincolnshire, IL 60069
www.lincolnshireil.gov
P: 847-913-2350
F: 847-883-9909
Page 1 of 6
STAMP HERE
LIQUOR LICENSE APPLICATION
Initial Application or
Change in Ownership
Date:
Liquor Class:
License Period Ending:
April 30, 20______
Address applying for liquor license (exact street address):
Telephone #:
APPLICANT
Applicant / Corporate name:
Name under which business is to be conducted (D.B.A.):
Business website:
Business Email:
Is the applicant an Individual or Partnership?
Is the applicant a Corporation or Club?
Yes No
Yes No
If the applicant is a club, does it qualify as defined in the Village of Lincolnshire’s
Village Code in relation to Liquor Control?
Yes No
LOCATION
Principal kind of business:
Length of time in principal kind of business:
What are the proposed days and hours of operation for the business for which this liquor license is applied
for?
Full description of the location including floor layout, specific floors, rooms, etc.:
Number of bars to be operated on premises:
Size of existing structure on the premises (square footage):
What is the projected full occupancy of the premises?
Bar/Lounge: Restaurant:
Submit an interior diagram of the current/proposed structure with the initial application.
Is the location of applicant’s business for which the license is sought within 100 feet of any
church, school (other than an institution of higher learning), hospital, home for aged or
indigent persons, or for veterans, their spouses or children?
Yes No
Does the applicant own the property or premises for which the license is sought?
Does the applicant have an option to purchase the property or premises?
Yes No
Yes No
1 Olde Half Day Road, Lincolnshire, IL 60069
www.lincolnshireil.gov
P: 847-913-2350
F: 847-883-9909
Page 2 of 6
LOCATION, CONTINUED
List owner(s) of the property or premises for which the application for the creation of a liquor license is
sought:
Owner Name:
Telephone #:
Residence Address:
Business Address:
Has the applicant signed a lease on such premises covering the full period for which the
license is sought? If yes, give the following information about the lessor:
Lessor Name:
Telephone #:
Address:
Period covered by
lease:
From:
To:
Options, full particulars:
Lessor’s Agent Name:
Telephone #:
Address:
Yes No
Submit a copy of the Deed or Contract for Deed or lease and any option agreements with initial
application.
Does applicant seek a license to sell alcoholic liquor upon the premises as a restaurant?
If so, are premises:
Maintained and held out to the public where meals are actually and regularly served?
Provided with adequate and sanitary kitchen and dining room equipment and capacity
with sufficient employees to prepare, cook and serve suitable food?
In accordance with the provisions of Section 3-3-2-2 of the Village of Lincolnshire
Village Code in relation to Liquor Control which sets forth the square footage and
seating allowances for restaurants?
Square Footage
% of Total
Dining area(s)
Lounge area(s)
Patron bar(s)
Seating Capacity
% of Total
Dining area(s)
Lounge area(s)
Patron bar(s)
Yes No
Yes No
Yes No
Yes No
1 Olde Half Day Road, Lincolnshire, IL 60069
www.lincolnshireil.gov
P: 847-913-2350
F: 847-883-9909
Page 3 of 6
LOCAL MANAGER
Will the business be conducted by a manager?
If yes, give the following information:
Manager Name:
Telephone #:
Address:
Driver’s License #:
State of Issuance:
Authority conferred upon him/her with relation to the operation or management of the
business for which the creation of a liquor license is sought:
Yes No
SOLE PROPRIETORSHIP / PARTNERSHIP / CORPORATION
Business address of the sole proprietorship/partnership/corporation:
List any other names this sole proprietorship/partnership/corporation is currently doing business as.
List any other names this sole proprietorship/partnership/corporation has previously done business as.
Date of Incorporation:
Under the laws of the State of:
Incorporation Certificate Number:
Is corporation qualified to do business in Illinois?
Date when corporation became qualified:
Yes No
Objects of corporation, as set forth in charter:
Submit a copy of the Charter of the Corporation with initial application.
If the sole proprietorship/partnership/corporation is held in a Trust, advise Trust Number and Location of
the Trust.
Submit a copy of the Land Trust Disclosure Statement with initial application.
List all beneficiaries of the Trust and percentage of ownership. (Must total 100%)
Name
%
ILLINOIS CORPORATE REGISTERED AGENT
Full Name:
Date of Birth:
Residence Address:
Telephone #:
Driver’s License #:
State of Issuance:
1 Olde Half Day Road, Lincolnshire, IL 60069
www.lincolnshireil.gov
P: 847-913-2350
F: 847-883-9909
Page 4 of 6
INDIVIDUALS / PARTNERS / OFFICERS / DIRECTORS / STOCKHOLDERS
WITH MORE THAN 5% OWNERSHIP
Full Name:
Title:
Date of Birth:
Residence Address:
Telephone #:
Driver’s License #:
State of Issuance:
Full Name:
Title:
Date of Birth:
Residence Address:
Telephone #:
Driver’s License #:
State of Issuance:
Full Name:
Title:
Date of Birth:
Residence Address:
Telephone #:
Driver’s License #:
State of Issuance:
Full Name:
Title:
Date of Birth:
Residence Address:
Telephone #:
Driver’s License #:
State of Issuance:
Full Name:
Title:
Date of Birth:
Residence Address:
Telephone #:
Driver’s License #:
State of Issuance:
Full Name:
Title:
Date of Birth:
Residence Address:
Telephone #:
Driver’s License #:
State of Issuance:
Full Name:
Title:
Date of Birth:
Residence Address:
Telephone #:
Driver’s License #:
State of Issuance:
Full Name:
Title:
Date of Birth:
Residence Address:
Telephone #:
Driver’s License #:
State of Issuance:
1 Olde Half Day Road, Lincolnshire, IL 60069
www.lincolnshireil.gov
P: 847-913-2350
F: 847-883-9909
Page 5 of 6
INDIVIDUALS / PARTNERS / OFFICERS / DIRECTORS / STOCKHOLDERS
WITH MORE THAN 5% OWNERSHIP, CONTINUED
Does the applicant or partner (if Individual or Partnership) or any officer, manager, agent,
director of the corporation, or any stockholder(s) have an interest in or hold any other
current licenses providing for the sale or distribution, at retail or wholesale, of alcoholic
liquor?
If so, provide the name and address of the business(es) as well as the State and State
Liquor License Number:
Have any hearings been conducted regarding the conduct and/or operation of any of the
above listed businesses by any State, County or municipal agency?
If so, provide the date, particulars and disposition:
Yes No
Yes No
Has any manufacturer, distributor or importing distributor directly or indirectly furnished,
loaned or rented any interior decorations other than signs for inside or outside use
(except signs existing prior to February 1, 1934), costing in aggregate more than
$100.00 in any one calendar year for use in or about premises for which the creation of
a liquor license is sought?
Yes No
Has any manufacturer, importing distributor or distributor directly or indirectly paid or
agreed to pay for this license, advanced money or anything else of value or any credit
(other than merchandising credit in the ordinary course of business for a period not to
exceed 90 days), or is such person directly or indirectly interested in the ownership,
conduct or operation of the place of business? (other than interior decorations and signs
mentioned previously)
Yes No
Is the applicant engaged in the manufacture of alcoholic liquors?
Yes No
Has any applicant, partner, officer, manager or director of said corporation, or any
stockholder or stockholders owning in aggregate more than 5% of the stock of such
corporation, made application for a similar license on any premises other than those
described in this application?
Yes No
Has any applicant, partner, officer, manager or director of said corporation, or any
stockholder or stockholders owning in aggregate more than 5% of the stock of such
corporation, ever been convicted of any felony under and Federal or State law?
Yes No
Has any applicant, partner, officer, manager or director of said corporation, or any
stockholder or stockholders owning in aggregate more than 5% of the stock of such
corporation, ever been convicted of being the keeper of a house of ill fame, or of
pandering or other crime opposed to decency and morality?
Yes No
Has any applicant, partner, officer, manager or director of said corporation, or any
stockholder or stockholders owning in aggregate more than 5% of the stock of such
corporation, ever been convicted of a violation of any Federal or State liquor law since
February 1, 1934?
Yes No
Is any law enforcing official, mayor, member of the village board of trustees, member of
a county board or state legislature or appointed officer of the executive branch of state
government directly or indirectly interested in the business for which the creation of a
liquor license is sought?
Yes No
Is any applicant, partner, officer, manager, director, stockholder or stockholders of the
corporation disqualified to receive a license under the liquor control provisions of the
Lincolnshire Village Code (as from time to time amended), or other ordinances of the
Village or laws of the State of Illinois?
Yes No
Has any license previously issued to the applicant or partner (if Individual or Partnership)
or any officer, manager, agent, director of the corporation, or any stockholder(s) been
revoked, suspended or assessed a fine for any reason, by any Federal, State or local
authority?
Yes No
If you answered yes to any of the above, please give full particulars including dates and locations of
offenses.
1 Olde Half Day Road, Lincolnshire, IL 60069
www.lincolnshireil.gov
P: 847-913-2350
F: 847-883-9909
Page 6 of 6
Was this application prepared by someone other than the applicant? If so, provide:
Name:
Relation to applicant:
Address:
Yes No
By the signing of the application, the applicant agrees to and hereby authorizes the Village of Lincolnshire
and its agents to conduct whatever investigation that may be deemed necessary to confirm the above
indicated facts, or otherwise to confirm that the applicant is lawfully permitted to obtain a liquor license
under the liquor control provisions of the Lincolnshire Village Code (as amended from time to time), or
other ordinances of the Village of Lincolnshire and the laws of the State of Illinois.
Any misrepresentation, omission or false statement on this application or in regards to any information
provided during the application process, shall constitute grounds for the termination of any further
consideration of the application or in the rejection of the application. If any such misrepresentation,
omission or false statement, as mentioned above, is discovered after the application for a liquor license
has been authorized, and a liquor license issued by the Mayor and board of Trustees of the Village of
Lincolnshire, said misrepresentation, omission or false statement shall constitute grounds for the
immediate revocation of said liquor license by the Liquor Control Commissioner.
Approval of application of license/permit shall not be held to permit or be an approval of any violation of
the provisions of the Lincolnshire Village Code.
Any changes in Manager must be reported to the Liquor Control Commissioner with 10 days
after the new appointment.
AFFIDAVIT
STATE OF ILLINOIS
COUNTY OF LAKE
The undersigned swear (or affirm) that the sole proprietorship, partnership, or
corporation in whose name this application is made, will not violate any of the
ordinances of the Village of Lincolnshire, or the laws of the State of Illinois or of
the United States of America, in the conduct of the place of business described
herein and that the statements contained in this application are true and correct.
If applicant is an Individual or Partnership,
Subscribed and sworn before me this sign here
_____ day of _____________ , 20 ____ ________________________ Individual / Partner
_________________________________ ________________________ Partner
Notary Public
If applicant is a Corporation, sign here
________________________ President
[NOTARY SEAL] ________________________ Secretary
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Liquor License Application

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Completed 13 July 2020

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