Fillable On Premise Prequalification

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On Premise Prequalification

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Page 1 of 5
Form L-ON (09/2019)
ON-PREMISE
PREQUALIFICATION PACKET
L-ON (9/2019)
Submit this packet to the proper governmental entities to obtain certification for the type of license/permit for
which you are applying as required by Sections 11.37, 11.39, 11.46(b), 61.37, 61.38, 61.42 and Rule §33.13
Contact your local TABC office to verify requirements of Sections 11.391 and 61.381 as you may be required to
post a sign at your proposed location 60-days prior to the issuance of your license/permit.
All statutory and rule references mentioned in this application refer to and can be found in the Texas Alcoholic Beverage
Code or Rules located on our website. www.tabc.texas.gov/laws/code_and_rules.asp
LOCATION INFORMATION
1.
Application for: Original Add Late Hours Only License/Permit Number
Reinstatement Reinstatement and Change of Trade Name License/Permit Number
Change of Location Change of Location and Trade Name License/Permit Number
2.
Type of On-Premise License/Permit
BG Wine and Beer Retailer’s Permit
LB Mixed Beverage Late Hours Permit
BE Beer Retail Dealer’s On-Premise License
MI Minibar Permit
BL Retail Dealer’s On-Premise Late Hours License
CB Caterer’s Permit
BP Brewpub License
FB Food and Beverage Certificate
V Wine & Beer Retailer’s Permit for Excursion Boats
PE Beverage Cartage Permit
MB Mixed Beverage Permit
RM Mixed Beverage Restaurant Permit with FB
O Private Carrier’s Permit –Brewpubs (BP) with a BG only
E Local Cartage Permit - Wine/Beer retailers (BG) Only
3.
Indicate Primary Business at this Location
Restaurant
Bar
Grocery/Market
Miscellaneous
_________________
4.
Trade Name of Location (Name of restaurant, bar, store, etc.)
5.
Location Address
City
County
State
Zip Code
6.
Mailing Address
City
State
Zip Code
7.
Business Phone No.
Alternate Phone No.
E-mail Address
OWNER INFORMATION
8.
Type of Owner
Individual
Corporation
City/County/University
Partnership
Limited Liability Company
Other
Limited Partnership
Joint Venture
Limited Liability Partnership
Trust
9.
Owner of Business/Applicant (Name of Corporation, LLC, etc.)
PRIMARY CONTACT PERSON
The primary contact person should be a person who can answer questions TABC may have about the application. The contact phone
and email are mandatory and must be active and updated regularly. If additional information is needed, it will be requested from
this contact person. Delays in responding to requests may delay the processing and approval of your license/permit.
10.
Contact Person:
Relation to Business:
Phone (mandatory):
Email (mandatory):
TABC DATESTAMP
________________
________________
________________
Page 2 of 5
Form L-ON (09/2019)
11.
Are you, the applicant a veteran-owned business? Yes No
12.
Are you, the applicant a Historically Underutilized Business (HUB)? Yes No
13.
As indicated on the chart, enter the individuals that pertain to your business type:
(For additional space, use Form L-OIC)
Individual/Individual Owner
Limited Liability Company/All Officers or Managers
Partnership/All Partners
Joint Venture/Venturers
Limited Partnership/All General Partners
Trust/Trustee(s)
Corporation/All Officers
City, County, University/Official
Last Name
First Name
MI
Title
Last Name
First Name
MI
Title
Last Name
First Name
MI
Title
MEASUREMENT INFORMATION
Section 109.31 et seq.
14.
Will your business be located within 300 feet of a church or public hospital? Yes No
NOTE: For churches or public hospitals measure from front door to front door, along the property lines of the street fronts and in a
direct line across intersections.
15.
Will your business be located within 300 feet of any private/public school, day care or child care facility? Yes No
15.a
If “YES,” are the facilities located on different floors or stories of the building? Yes No
NOTE:
NOTE:
NOTE:
For private/public schools, day care centers and child care facilities measure in a direct line from the nearest property line of
the school, day care center or child care facility to the nearest property line of the place of business, and in a direct line
across intersections.
For multistory building: businesses may be within 300 feet of a day care center or child care facility as long as the facilities
are located on different floors of the building.
If located on or above the fifth story of a multistory building: measure in a direct line from the property line of the private/public
school to property line of your place of business in a direct line across intersections vertically up the building at the property
line to the base of the floor on which your business is located.
16.
Will your business be located within 1,000 feet of a private school? Yes No
17.
Will your business be located within 1,000 feet of a public school? Yes No
60-DAY SIGN
18.
If required under Section 11.391 and 61.381, enter the exact date the 60-Day sign was posted
at your location.
Exact Date (MM/DD/YYYY)
ALL APPLICANTS
19. IF YOUR LOCATION IS NOT WITHIN THE CITY LIMITS, CHECK HERE
I, the applicant, have confirmed I am not located in the city limits of any city, therefore, city certifications are not
required.
COMPLETE THE FOLLOWING CHECKLIST BEFORE SUBMITTING YOUR APPLICATION
Per Sec. 102.01, a tied house is defined as any overlapping ownership between those engaged in the alcoholic beverage
industry at different levels of the three-tier system. No person having an interest in a permit issued by TABC may secure or
hold, directly or indirectly, an ownership interest in a business on a different level.
All required forms have been completed.
Yes No
I have reviewed all forms to ensure they are complete.
Yes No
I have obtained all required local and state certifications (pages 3-5).
Yes No
All application packets have been notarized.
Yes No
Phone numbers and email address for Contact Person are up to date.
Yes No
All additional documentation as required by the application packets is attached
Yes No
If required, out of state criminal history checks are attached (PHS #7).
Yes No N/A
Certification of publication in local newspaper has been completed (page 5).
Yes No N/A
A copy of the newspaper publication is attached (page 5).
Yes No N/A
Page 3 of 5
Form L-ON (09/2019)
WARNING AND
SIGNATURE
IF APPLICANT IS SHOWN AS:
WHO MUST SIGN:
Proprietorship
Individual Owner
Partnership
Partner
Corporation
Officer
Limited Partnership
General Partner
Limited Liability Partnership
General Partner
Limited Liability Company
Officer/Manager
WARNING: Section 101.69 of the Texas Alcoholic Beverage Code states: “…a person who makes a false statement or false
representation in an application for a permit or license or in a statement, report, or other instrument to be filed with the Commission and
required to be sworn commits an offense punishable by imprisonment in the Texas Department of Criminal Justice for not less than 2
nor more than 10 years.”
I, UNDER PENALTY OF LAW, HEREBY SWEAR THAT I HAVE READ ALL THE INFORMATION PROVIDED IN THE APPLICATION AND ANY ATTACHMENTS AND
THE INFORMATION IS TRUE AND CORRECT. I ALSO UNDERSTAND ANY FALSE STATEMENT OR REPRESENTATION IN THIS APPLICATION CAN RESULT IN
MY APPLICATION BEING DENIED AND/OR CRIMINAL CHARGES FILED AGAINST ME. I ALSO AUTHORIZE THE TEXAS ALCOHOLIC BEVERAGE COMMISSION
TO USE ALL LEGAL MEANS TO VERIFY THE INFORMATION PROVIDED.
PRINT
NAME
SIGN
HERE
TITLE
Before me, the undersigned authority, on this day of , 20 , the person whose name is signed to
the foregoing application personally appeared and, duly sworn by me, states under oath that he or she has read the said
application and that all the facts therein set forth are true and correct.
SIGN
HERE
NOTARY PUBLIC
S E A L
CERTIFICATE OF CITY SECRETARY (FOR MB, RM & V)
Section 11.37
I hereby certify on this day of , 20 , that the location for which the
license/permit is sought is inside the boundaries of this city or town, in a “wet” area for such license/permit, and not
prohibited by charter or ordinance in reference to the sale of such alcoholic beverages.
SIGN
HERE , TEXAS
City Secretary/Clerk City
S E A L
CERTIFICATE OF CITY SECRETARY (FOR BG & BE)
Section 11.37 & 61.37
I hereby certify on this day of , 20 , that the location for which the
license/permit is sought is inside the boundaries of this city or town, in a “wet” area for such license/permit, and not
prohibited by charter or ordinance in reference to the sale of such alcoholic beverages.
Election for given location was held for:
legal sale of all alcoholic beverages
legal sale of all alcoholic beverages except mixed beverages
legal sale of all alcoholic beverages including mixed beverages
legal sale of beer/wine (17%) on-premise AFTER Sept. 1, 1999
legal sale of beer/wine (14%) on-premise BEFORE Sept. 1, 1999
OR IF ABOVE DOES NOT APPLY:
Be advised the location must have had two election passages per Section 25.14 or Section 69.17 of the TABC Code. One for beer
and wine off-premise and one for mixed beverage.
legal sale of beer and wine for off-premise consumption only
AND EITHER:
legal sale of mixed beverages
OR
legal sale of mixed beverages in restaurants by food and beverage certificate holders
(applicant must apply for FB with BG or BE)
SIGN
HERE , TEXAS
City Secretary/Clerk City
S E A L
Page 4 of 5
Form L-ON (09/2019)
CERTIFICATE OF CITY SECRETARY FOR LATE HOURS LICENSE/PERMIT
(LB & BL)
Chapters 29 & 70 et seq.
I hereby certify on this day of , 20 , that one of the below is correct:
The governing body of this city has by ordinance authorized the sale of mixed beverages between midnight and 2:00
A.M.; or
The governing body of this city has by ordinance authorized the sale of beer between midnight and
A.M.; or
The population of the city or county where premises are located was 500,000 or more according to the 22
nd
Decennial
Census of the United States as released by the Bureau of the Census on March 12, 2001; or
The population of the city or county where premises are located was 800,000 or more according to the last Federal
Census (2010).
SIGN
HERE , TEXAS
City Secretary/Clerk City
S E A L
CERTIFICATE OF COUNTY CLERK (FOR MB, RM & V)
Section 11.37
I hereby certify on this day of , 20 , that the location for which the
license/permit is sought is in a “wet” area for such license/permit, and is not prohibited by any valid order of the
Commissioner’s Court.
SIGN
HERE COUNTY
County Clerk
S E A L
CERTIFICATE OF COUNTY CLERK (FOR BG & BE)
Section 11.37 & 61.37
I hereby certify on this day of , 20 , that the location for which the
license/permit is sought is in a “wet” area and is not prohibited by any valid order of the Commissioner’s
Court.
Election for given location was held for:
legal sale of all alcoholic beverages
legal sale of all alcoholic beverages except mixed beverages
legal sale of all alcoholic beverages including mixed beverages
legal sale of beer/wine (17%) on-premise AFTER Sept. 1, 1999
legal sale of beer/wine (14%) on-premise BEFORE Sept. 1, 1999
OR IF ABOVE DOES NOT APPLY:
Be advised the location must have had two election passages per 25.14 or 69.17 of the TAB Code. One for beer and wine off-premise
and one for mixed beverage.
legal sale of beer and wine for off-premise consumption only
AND EITHER:
legal sale of mixed beverages
OR
legal sale of mixed beverages in restaurants by food and beverage certificate holders
(applicant must apply for FB with BG or BE)
SIGN
HERE COUNTY
County Clerk
S E A L
Page 5 of 5
Form L-ON (09/2019)
CERTIFICATE OF COUNTY CLERK FOR LATE HOURS LICENSE/PERMIT (LB & BL)
Chapters 29 & 70 et seq
I hereby certify on this day of , 20 , that one of the below are correct:
The Commissioner’s Court of the county has by order authorized the sale of mixed beverages between midnight and
2:00 A.M.; or
The Commissioner’s Court of the county has by order authorized the sale of beer between midnight and
A.M.; or
The population of the city or county where premises are located was 500,000 or more according to the 22
nd
Decennial
Census of the United States as released by the Bureau of the Census on March 12, 2001; or
The population of the city or county where premises are located was 800,000 or more according to the last Federal
Census (2010).
SIGN
HERE COUNTY
County Clerk
S E A L
COMPTROLLER OF PUBLIC ACCOUNTS CERTIFICATE
Section 11.46 (b) & 61.42 (b)
This is to certify on this day of , 20 , the applicant holds or has applied for
and satisfies all legal requirements for the issuance of a Sales Tax Permit under the Limited Sales, Excise and Use Tax Act
or the applicant as of this date is not required to hold a Sales Tax Permit.
Sales Tax Permit Number Outlet Number
Print Name of Comptroller Employee
Print Title of Comptroller Employee
SIGN
HERE FIELD OFFICE
S E A L
PUBLISHER’S AFFIDAVIT (FOR MB, LB, RM, BP, BG, BE, BL & V)
Section 11.39 and 61.38
Name of newspaper
ATTACH PRINTED
COPY OF THE
NOTICE HERE
Hover over to see example
City, County
Dates notice published in daily/weekly
newspaper (MM/DD/YYYY)
Publisher or designee certifies attached notice was published in newspaper stated on dates shown.
Signature of publisher or designee
Sworn to and subscribed
before me on this date (MM/DD/YYYY)
Signature of Notary Public
S E A L
Page 1 of 1
Form L-OIC (09/2019)
OWNERSHIP INFORMATION
Continued for Prequalification Packet
L-OIC
(09/2019)
LOCATION INFORMATION
1.
Trade Name of Location
2.
Location Address
City
County
State
Zip Code
OWNER INFORMATION
3.
Type of Owner
Individual
Corporation
City/County/University
Partnership
Limited Liability Company
Other
Limited Partnership
Joint Venture
Limited Liability Partnership
Trust
Last Name
First Name
MI
Title
Last Name
First Name
MI
Title
Last Name
First Name
MI
Title
Last Name
First Name
MI
Title
Last Name
First Name
MI
Title
Last Name
First Name
MI
Title
Last Name
First Name
MI
Title
Last Name
First Name
MI
Title
Last Name
First Name
MI
Title
Last Name
First Name
MI
Title
Last Name
First Name
MI
Title
Last Name
First Name
MI
Title
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On Premise Prequalification

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Completed 21 July 2020

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