Fillable Liquor License Application (CITY OF KANKAKEE IL)

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Liquor License Application (CITY OF KANKAKEE IL)

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APPLICATION FOR RETAIL LICENSE TO SELL ACOHOLIC BEVERAGES
Liquor License #:
Date:
Fee:
Class:
Proprietorship:
Partnership:
Corporation:
LLC:
IMPORTANT: STATE NAME UNDER WHICH THE BUSINESS IS TO BE OPERATED EXACTLY AS IT
WILL APPEAR ON BOTH THE CITY AND STATE LICENSE
Liquor License:
Address of licensed premise:
Property Tax Identification Number (PIN):
Applicant’s connection to real estate on which licensed premises will be operated
OWN: ❑ LEASE/RENT: ❑ PURCHASING by INSTALLMENT CONTRACT: ❑
SECTION 1 TO BE COMPLETED BY ALL APPLICANTS
Applicant’s Sales Tax Number:
Applicant’s Federal ID Number:
State of Illinois Liquor License Number:
Expiration Date:
Name the RESIDENT MANAGER WHO IS A RESIDENT OF KANKAKEE COUNTY
Name:
Social Security Number: XXX-XX- ___ ___ ___ ___
Telephone:
Email:
Address:
City, State, ZIP Code:
Previous address if less than one (1) year:
SECTION 2 SOLE PROPRIETORSHIP
Applicant/’s Name/s (Include any and all aliases)
Email Address:
Last Name:
First Name:
Middle Initial:
First Alias:
Second Alias:
City, State, ZIP Code:
Length of Residence:
Telephone Number:
Previous Residence if Less Than One Year Above:
Birthdate:
Birth Place:
Social Security #: XXX-XX- ___ ___ ___ ___
United States Citizen: Yes _____ No _____ If yes, by Birth __________ or Naturalization __________
Page 1
SECTION 3 CORPORATION, PARTNERSHIP OR LLC INFORMATION PAGE 2
If a corporation is applicant, state the corporate name and address of principal place of business.
Name: Telephone:
Address: City, State, Zip:
State of Incorporation: Date of Incorporation:
Registered agent’s name:
Address: Telephone:
ATTACH A COPY OF ARTICLES OF INCORPORATION TO THIS APPLICATION
State the name, title and residence address of all corporate officers and directors.
Name: _________________________________ Title: _____________________Residence Address: _____________________________________
Name: _________________________________ Title: _____________________Residence Address: _____________________________________
Name: _________________________________ Title: _____________________Residence Address: _____________________________________
Name: _________________________________ Title: _____________________Residence Address: _____________________________________
Name: _________________________________ Title: _____________________Residence Address: _____________________________________
State the names, residence address and social security number of all shareholders owning at least five percent (5%) of the issued corporate
stock.
Name: _________________________________ SS# ***-**-__ __ __ __ Residence Address: ______________________________________
Name: _________________________________ SS# ***-**-__ __ __ __ Residence Address: ______________________________________
Name: _________________________________ SS# ***-**-__ __ __ __ Residence Address: ______________________________________
Name: _________________________________ SS# ***-**-__ __ __ __ Residence Address: ______________________________________
Name: _________________________________ SS# ***-**-__ __ __ __ Residence Address: ______________________________________
If partnership, state full name of all partners. ATTACH COPY OF PARTNERSHIP AGREEMENT, IF ANY
Name: ____________________________________________Address: ____________________________________________________________
Birth Date: _________________________________Birth Place: __________________________________________ SS# ***-**-__ __ __ __
Name: ____________________________________________Address: ____________________________________________________________
Birth Date: _________________________________Birth Place: __________________________________________ SS# ***-**-__ __ __ __
Name: ____________________________________________Address: ____________________________________________________________
Birth Date: _________________________________Birth Place: __________________________________________ SS# ***-**-__ __ __ __
Name: ____________________________________________Address: ____________________________________________________________
Birth Date: _________________________________Birth Place: __________________________________________ SS# ***-**-__ __ __ __
SECTION 4 CORPORATION, PARTNERSHIP OR LLC INFORMATION PAGE 3
Have you ever been convicted of a felony or misdemeanor (excluding traffic violation)? Yes: ____________ No: ____________
If yes, state type of conviction, date of conviction and disposition of case: __________________________________________________________
______________________________________________________________________________________________________________________
Have you ever had any interest in a license to sell alcoholic beverages that has been revoked by any jurisdiction? Yes: _____ No: _____
If yes, state the reason and the date of the suspension or revocation. ______________________________________________________________
______________________________________________________________________________________________________________________.
Has any applicant been convicted either civilly or criminally of being delinquent in forwarding retailer’s occupational taxes to the state
Department of Revenue? Yes: ____________ No: ____________
If yes, state the type of conviction, date of conviction and disposition of the case: ____________________________________________________
______________________________________________________________________________________________________________________.
Is the resident manager prohibited from holding a license under Section 120, Chapter 43, Illinois Revised Statutes 1977, Entitled “An Act Relating
to Alcoholic Liquor?” Yes: ____________ No: ____________
Are the premises for which the license is sought within 100 feet of any church, school, hospital, home for the aged, home for the indigent
persons, or home for veterans, their wives or children? Yes: ____________ No: ____________
If applicant is a club, does it comply with the Section 95.24 Illinois Revised Statutes 1977, entitled “An Act Relating to Alcoholic Liquor?”
Yes: ____________ No: ____________
Does applicant agree to produce his/her books, records (including invoices) at all reasonable times for inspection by the Local Liquor License
Commissioner or authorized agent? Yes: ____________ No: ____________
Does the applicant seek a license to sell liquor on the premises used as a restaurant? Yes: ____________ No: ____________
If yes, are meals actually and regularly served? Yes: ____________ No: ____________
Are the premises provided with adequate sanitary kitchen and dining room equipment and capacity, with sufficient employees to prepare, cook
and serve suitable food? Yes: ____________ No: ____________
Have you obtained a license from the Kankakee County Department of Public Health to operate a restaurant? Yes: _____ No: _____
Has any manufacturer, distributor or importing distributor of liquor directly or indirectly furnished, loaned or rented any interior decorations
other than signs for inside or outside use costing the aggregate more than $100 in any one calendar year, for use in or about said premises, or
paid, or agreed to pay, for this license, advance money or anything else of value, or any credit, other than 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? Yes: ____________ No: ____________
Are you currently appointed or elected to any public office? Yes: ____________ No: ____________
If yes, what public office do you hold? _______________________________________________________________________________________
Has any license previously issued to you by State, Federal or Local authorities been suspended or revoked? Yes: _____ No: _____
If yes, state the reason and the date of the suspension or revocation. ______________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________.
Do you currently owe the City of Kankakee for any fines, taxes or services? Yes: ____________ No: ____________
Does applicant agree to report any changes on this application to the Local Liquor License Commissioner within seven (7) days of the change?
Yes: ____________ No: ____________
SECTION 5 TO BE COMPLETED BY ALL APPLICANTS PAGE 4
The undersigned covenants and agrees:
❑ To keep the premises free at all times from the presence of disorderly persons, and to prevent any immoral practices thereon.
❑ To keep the premises at all times free from gambling of any sort whatsoever and constantly exclude from such premises any and all
apparatus that is ordinarily, or may be, employed in games of chance or in gambling except for liquor license holders who are fully
licensed to operate gambling machines pursuant to the Illinois Gaming Act 230 ILCS 40/1 et seq.
❑ To prevent violation upon the premises of any law or ordinance, Federal, State or City.
❑ No licensee shall sell, give or deliver alcohol to any minor, or to any intoxicated person or to any person known by him to be a habitual
drunkard, spendthrift or insane, feeble-minded or distracted person.
❑ To be present as requested by the local Liquor License Commissioner to permit and consent to the taking of fingerprints of the said
applicant for the purpose of investigating the background of said applicant, to which taking and submitting of fingerprints this applicant
does hereby expressly consent.
❑ That any misstatement made by the applicant herein, or any violation of the terms and conditions of this application or of any of the laws,
Statues, ordinances, resolutions and covenants above set forth, shall be the cause of revocation by the Kankakee City Liquor License
Commissioner of the license herein applied for.
Signature: ______________________________________________________________
Notes:
SECTION 6 PAGE 5
A F F I D A V I T
STATE OF ILLINOIS )
) SS
COUNTY OF KANKAKEE )
The undersigned being first duly sworn, states that s/he will not violate any of the Ordinances or Resolutions of the City of
Kankakee or the laws of the State of Illinois or 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 to the best of his/her knowledge and belief.
_____________________________________________________
Subscribed and Sworn to
Before me this ______day of
_______________________, 20____
______________________________________________________
NOTARY PUBLIC
IMPORTANT: If application is a corporation, it is imperative that the application by signed by the President and Secretary of
corporation and that the corporation seal be affixed. Use the following affidavit.
STATE OF ILLINOIS )
) SS
COUNTY OF KANKAKEE )
The undersigned being first duly sworn, state that the corporation in whose name this application is made will not violate any of the
Ordinances or Resolutions of the City of Kankakee or the laws of the State of Illinois or of the United States of America in the
conduct of the business described herein and that the statements contained in this application are true and correct to the best of our
knowledge and belief.
_________________________________________________ _________________________________________________
PRESIDENT SECRETARY
Subscribed and Sworn to CORPORATE SEAL
Before me this ______day of
_______________________, 20____
______________________________________________________
NOTARY PUBLIC
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Liquor License Application (CITY OF KANKAKEE IL)

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Completed 14 July 2020

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