Fillable Liquor License One Day Application

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Liquor License One Day 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 4
STAMP HERE
LIQUOR LICENSE APPLICATION
OFFICE USE ONLY
License #:
One Day License
Application
Application Date:
Liquor Class:
G
License Date(s):
EVENT INFORMATION
Name of Event:
Event Location (exact street address):
Event Start Date:
Event End Date:
Event Hours:
Type of alcoholic beverages being provided:
APPLICANT
Applicant / Corporate name:
Name under which business is to be conducted (D.B.A.):
Telephone #:
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
EVENT MANAGER (Person responsible for alcohol sales on-site)
Event Manager Name:
Telephone #:
Address:
Driver’s License #:
State of Issuance:
Are all sellers, servers and those who check ID’s
BASSET certified? Yes No
CLUB / 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
1 Olde Half Day Road, Lincolnshire, IL 60069
www.lincolnshireil.gov
P: 847-913-2350
F: 847-883-9909
Page 2 of 4
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 3 of 4
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 4 of 4
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.
All alcohol sellers and servers, and those who check IDs must have Beverage Alcohol Sellers
and Servers Education and Training (BASSET) Certification.
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 One Day Application

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Completed 13 July 2020

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