1 Olde Half Day Road, Lincolnshire, IL 60069
Page 1 of 2
STAMP HERE
LIQUOR LICENSE MANAGER
License #:
License Period Ending:
April 30, 20______
Address applying for liquor license (exact street address):
Give the name of the person who appointed you and date of appointment:
Are you a U.S. Citizen?
Yes No
If a naturalized citizen, when and where were you naturalized?
Have you ever been convicted of any felony under any Federal or State law?
Have you ever been convicted of being the keeper of a house of ill fame, pandering
or other crime opposed to decency or morality?
Have you ever been convicted of a violation of any Federal or State liquor law since
February 1, 1934?
Has any business in which you were a manager ever had their liquor license revoked,
suspended or assessed a fine for any reason by Federal, State or local authorities?
Yes No
Yes No
If you answered yes to any of the above, please give full particulars including dates and locations of
offenses.
State Law requires that all sellers, servers and those who check ID’s be BASSET certified or under the
direct supervision of someone who is BASSET certified. Proof of BASSET certification must be available
for inspection by state and/or local liquor authorities at all times.
At the business applying for the liquor license, are all required individuals BASSET certified?
Yes No
Submit Copy of Manager’s BASSET certification with this document.
Approval of application for license/permit shall not authorize or be an approval for any violation of the
provisions of the Village of Lincolnshire Code.
Any changes in Manager must be reported to the Liquor Control Commissioner with 10 days
after the new appointment.
