Fill - Free fillable Off Premises Catering Application Packet Writable (City of Dahlonega) PDF form

City of Dahlonega

465 Riley Road

Dahlonega, GA 30533

(706) 864-6133

www.dahlonega-ga.gov

Information for Application for Off-Premises Alcoholic Beverage Catering Permit and

Excise Tax Acknowledgment

Pursuant to Article IV of Ordinance 2005-2, an alcoholic beverage caterer means any retail dealer licensed pursuant to

the alcoholic beverage ordinance of the City of Dahlonega or any licensed Alcoholic Beverage Caterer pursuant to

O.C.G.A. § 3-11-1 et seq who provides alcohol at authorized events or functions, special events, or special events

facilities. The permit requirements for an Off-Premises Alcoholic Beverage Catering Permit are listed below. Additional

details can be found in Ordinance 2005-2, Article IV.

1. Any caterer who possesses a valid Alcoholic Beverage License for Consumption on the Premises to sell or

otherwise dispense malt beverages, wine or distilled spirits by the drink may apply for an off-premises permit that

permits sales at authorized catered events or functions.

2. Each off-premises catering permit, authorized herein, and shall be valid only for the event for which the permit is

issued and in no event longer than a period of three consecutive days.

3. It shall be unlawful for any person to engage in, carry on, or conduct the sale or distribution of alcoholic

beverages off-premises and in connection with a catered event or function without first having obtained a permit as

provided herein.

4. A licensed alcoholic beverage caterer may sell or otherwise dispense only that which is authorized by his

alcoholic beverage license. For example, if the alcoholic beverage caterer possesses a valid license to sell malt

beverages, he may sell or otherwise dispense only malt beverages at the authorized catered event or function.

5. Sunday sales. An alcoholic beverage caterer wishing to cater an event or function on Sunday must possess a

valid Sunday sales license and comply with the requirements of state law with respect to the service of alcoholic

beverages on Sunday.

6. Excise taxes are imposed upon the sale of alcoholic beverages by a resident caterer as provided in Section 60 of

Ordinance 2005-2. Your initials here indicate that you are aware of the requirements of Section 60 of Ordinance 2005-2

regarding payment of Excise Tax and that you will remit payment of the Tax within the time prescribed. __________

(Initial)

7. Excise taxes are imposed upon the total of individual alcoholic beverage drinks served by a nonresident caterer in the

amounts set forth in Article VII, Section 60 of Ordinance 2005-2 and shall be paid within 30 days after the conclusion of

the catered event or function. Your initials here indicate that you are aware of the requirements of Section 60 of

Ordinance 2005-2 regarding payment of Excise Tax and that you will remit payment of the Tax within 30 days of the

conclusion of the event for which the permit is issued. __________ (Initial)

Please submit the following Application for Off-Premises Alcoholic Beverage Catering Permit and required

supplemental materials to the City of Dahlonega, located at 465 Riley Road, Dahlonega, Georgia 30533. If you

have questions, please do not hesitate to contact City Hall at (706) 864-6133.

City of Dahlonega

465 Riley Road

Dahlonega, GA 30533

(706) 864-6133

www.dahlonega-ga.gov

Permit Checklist

Application Requirements:

 Off-Premises Alcoholic Beverage Catering Permit Application Information and Excise Tax

acknowledgment.

 Applicant's Certification Affidavit (Notarized)

 SAVE Affidavit (Notarized)

 Application and Alcoholic Beverage Provider Information

 Copy of Alcoholic Beverage Provider's Alcohol License

 Copy of valid Occupational Tax Certificate

 Payment in full

City of Dahlonega

465 Riley Road

Dahlonega, GA 30533

(706) 864-6133

www.dahlonega-ga.gov

Application for Off-Premises Alcoholic Beverage Catering Permit

Business Organization Details:

Name of

Business/Organization

(Alcohol P r o v i d e r

): ________________________________________

Physical Business

/Organization

Address:

_____________________________________________________

_______________________________________________________________________

Mailing Address

: _______________________________________________________________________

______________________________________________________________________

Name of

Licensee: _______________________________________________________________________

Email: ____________________________________________________

Telephone Number: _______________

Signature of Licensee: ____________________________________________________________________________

Event

Details:

Name of Event: _____________________________________________________________________

Location of the Event (Physical Address): _______________________________________________

_______________________________________________

Date of Event: From: ________________ to: _________________

Duration of Event # of Days (cannot exceed 3 consecutive days): ________ days

Event Hours: From: ________ a.m. /p.m. To: ________________ a.m. /p.m.

Types & Quantity of Alcoholic Beverages to be served: _____________________________________

__________________________________________________________________________________

City of Dahlonega

465 Riley Road

Dahlonega, GA 30533

(706) 864-6133

www.dahlonega-ga.gov

Application for Off-Premises Alcoholic Beverage Catering Permit

(Page 2)

Property Details:

Name of Owner: ______________________________________________

Owner’s Address: ______________________________________________

______________________________________________

Owner’s Email: ______________________________________________

Owner’s Telephone: ______________________________________________

Permit and Administrative Fees Due upon Application:

TOTALS

Administrative Fee – Beer/Wine only

OR

Liquor only $50.00 _ $________

Administrative Fee – Beer/Wine

AND

Liquor $75.00 _ $________

Additional Fees for Non-Resident Caterers Due upon Application:

Off-Premises Permit Fee $50.00 $________

Background Check $40.00 _ X # Persons ____ $________

TOTAL FEES DUE: $________*

The total fees due shall be paid at the time of application for a Permit. In the event the

application is DENIED, the applicant shall receive a refund of only the per day Permit fee paid at the

time of application. All other fees are non-refundable.

City of Dahlonega

465 Riley Road

Dahlonega, GA 30533

(706) 864-6133

www.dahlonega-ga.gov

Application for Off-Premises Alcoholic Beverage Catering Permit Certification and Affidavit

Name of Event: ____________________________________________________________________________________

Brief Description of Event: ___________________________________________________________________________

__________________________________________________________________________________________________

Address of Event: _____________________________________________________

I hereby

agree that as a

condition

to the issuance of an Off-Premises Alcoholic Beverage Catering Permit,

the business

owner/sponsor

of the Event shall

indemnify

and hold the City

harmless

from

claims,

demand

or cause of action which may arise from

activities associated

with

the

event.

I

hereby solemnly

swear,

subject

to

criminal penalties

for false

swearing,

that the

statements

and

answers

made by me to the

foregoing questions

in this

application

for an Off-Premises Alcoholic Beverage

Catering Permit are

true,

and no false or

fraudulent statement

or answer is

made

herein to

procure

the

granting

of such

permit.

I

hereby

state and

understand

that should a

complaint

be filed

against

the

owner/sponsor

of

the

Event

for

violation

of any

regulation associated

with the

application

for the City of

Dahlonega Off-Premises

Alcoholic Beverage

Catering Permit

, the

permit

issued for the event will

immediately

become void and will not

reissue for the same

location.

Licensee Signature: ________________________________________________ Date: __________________

Sworn and Attested before me on this ___ day of _________________________, 20_____.

__________________________________

Notary Signature/Seal

Staff

Use

Only

Permit#:

Administrative

Fees:

Processed

By:

Approved/Denied

by:d

Permit

Fees:

Expiration Date:

Approval Date:

Denied

Date:

City of Dahlonega

465 Riley Road

Dahlonega, GA 30533

(706) 864-6133

www.dahlonega-ga.gov

O.C.G.A. §

50-36-1(e)(2)

Affidavit Verifying Status

for

City Public Benefit

**This form

is

required

for ALL

LICENSES/PERMITS

by

State

Law**

By

executing

this

affidavit

under oath, as an

applicant

for an Off-Premises Alcoholic Beverage Catering

Permit, as

referenced

in

O.C.G.A.

§ 50-36-1,

from the City of D

ahlonega,

Georgia, the

undersigned

applicant verifies

one of

the

following

with respect to my

application

for a public

benefit:

1) ____________ I

am

a United States

citizen

(Must

include

copy of

either current

State

Driver's

License,

Passport,

or

Military

ID)

2) ____________ I

am

a legal

permanent resident

of the United

States

*

(Must

include

a copy of your

current

State

Driver's

License and either a copy of your

Permanent

Resident Card or

Employment Authorization Card)

3) _________________ I

am

a

qualified

alien or

non-immigrant

under the Federal

Immigration

and

Nationality

Act with an alien

number

issued by the

Department

of

Homeland

Security

or other federal

immigration

agency.**

(Must

include

a copy of your

current

State

Driver's

License and either a copy of your

Permanent

Resident Card or

Employment Authorization Card)

**My

alien number

issued by the Department

of

Homeland Security

or other

federal

immigration

agency is:

The

undersigned applicant

also hereby ve r i fie s

that he or she is 18 years of age or older and has

provided

at

least one secure and

verifiable document,

as

required

by O.C.G.A.

§ 50-36-1(e) (1),

with this affidavit

.

The secure and

verifiable document provided

with this affidavit

can best be

classified as:

________________________________________________________________________

In making the above representation under oath, I understand that any person who knowingly and willfully makes a false,

fictitious or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. 16-10-20 and

face criminal penalties as allowed by such criminal statute.

_____________________________________ ________________________________

Signature of Applicant Date Printed Name of Applicant

SUBSCRIBED AND SWORN BEFORE ME

ON THIS D A Y O F , 2 0 .

N o t a r y P u b l i c

Fill Online, Printable, Fillable, Blank Off Premises Catering Application Packet Writable (City of Dahlonega) Form

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Fillable Off Premises Catering Application Packet Writable (City of Dahlonega)

Fill Online, Printable, Fillable, Blank Off Premises Catering Application Packet Writable (City of Dahlonega) Form

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