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Liquor Renewal Corp

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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 2
STAMP HERE
LIQUOR LICENSE RENEWAL
OFFICE USE ONLY
License #:
Corporate Liquor
License Renewal
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:
Number of bars to be operated on
premises:
Name of Local Manager:
In the past year:
• Have there been any changes to the physical location affecting the layout of the
business?
• Have there been any changes in ownership or corporate structure?
• Have there been any changes in local management?
Yes No
Yes No
Yes No
If you answered yes to any of the above, please indicate changes that occurred.
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.
1 Olde Half Day Road, Lincolnshire, IL 60069
www.lincolnshireil.gov
P: 847-913-2350
F: 847-883-9909
Page 2 of 2
AFFIDAVIT
STATE OF ILLINOIS
COUNTY OF LAKE
The undersigned swear (or affirm) that the 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.
________________________ President
Corporate Seal ________________________ Secretary
Subscribed and sworn before me this _______ day of ___________________ , 20 ______ .
_____________________________
[NOTARY SEAL] Notary Public
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Liquor Renewal Corp

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Completed 13 July 2020

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