Fillable Original Alcohol Beverage Retail License Application (Village of Mount Pleasant)

Fill Online, Printable, Fillable, Blank Original Alcohol Beverage Retail License Application (Village of Mount Pleasant) Form

Use Fill to complete blank online VILLAGE OF MOUNT PLEASANT (WI) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Original Alcohol Beverage Retail License Application (Village of Mount Pleasant)

On average this form takes 16 minutes to complete

The Original Alcohol Beverage Retail License Application (Village of Mount Pleasant) form is 1 page long and contains:

  • 0 signatures
  • 8 check-boxes
  • 61 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Village of Mount Pleasant

BROWSE VILLAGE OF MOUNT PLEASANT (WI) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
1. The named Individual Partnership Limited Liability Company
Corporation/NonprotOrganization
herebymakesapplicationforthealcoholbeveragelicense(s)checkedabove.
2. Name(individual/partnersgivelastname,rst,middle;corporations/limitedliabilitycompaniesgiveregisteredname):
An “Auxiliary Questionnaire,” Form AT-103, must be completed and attached to this application by each individual applicant, by each member of a
partnership, and by each ofcer, director and agent of a corporation or nonprot organization, and by each member/manager and agent of a limited
liability company.Listthename,title,andplaceofresidenceofeachperson.
Title Name (Last, First, M.I.) Home Address Post Ofce & Zip Code
President/Member
Vice President/Member
Secretary/Member
Treasurer/Member
Agent
Directors/Managers
3. Trade Name Business Phone Number
4. AddressofPremises PostOfce&ZipCode
5. Isindividual,partnersoragentofcorporation/limitedliabilitycompanysubjecttocompletionoftheresponsiblebeverageserver
trainingcourseforthislicenseperiod? .............................................................................. Yes No
6. Istheapplicantanemployeoragentof,oractingonbehalfofanyoneexceptthenamedapplicant? .............................. Yes No
7. Doesanyotheralcoholbeverageretaillicenseeorwholesalepermitteehaveanyinterestinorcontrolofthisbusiness?. . . . . . . . . . . . . . . Yes No
8. (a) Corporate/limited liability company applicants only: Insertstate anddate ofregistration.
(b) Isapplicantcorporation/limitedliabilitycompanyasubsidiaryofanyothercorporationorlimitedliabilitycompany? ................ Yes No
(c) Doesthecorporation,oranyofcer,director,stockholderoragentorlimitedliabilitycompany,oranymember/manageror
agentholdanyinterestinanyotheralcoholbeveragelicenseorpermitinWisconsin? ...................................... Yes No
(NOTE: All applicants explain fully on reverse side of this form every YES answer in sections 5, 6, 7 and 8 above.)
9. Premisesdescription:Describebuildingorbuildingswherealcoholbeveragesaretobesoldandstored.Theapplicantmustinclude
allroomsincludinglivingquarters,ifused,forthesales,service,consumption,and/orstorageofalcoholbeveragesandrecords.(Alcoholbeverages
maybesoldandstoredonlyonthepremisesdescribed.)
10. Legaldescription(omitifstreetaddressisgivenabove):
11. (a) Wasthispremiseslicensedforthesaleofliquororbeerduringthepastlicenseyear? ...................................... Yes No
(b) Ifyes,underwhatnamewaslicenseissued?
12. DoestheapplicantunderstandtheymustregisterasaRetailBeverageAlcoholDealerwiththefederalgovernment,Alcoholand
TobaccoTaxandTradeBureau(TTB)byling(TTBform5630.5d)beforebeginningbusiness?[phone1-877-882-3277] .............. Yes No
13. DoestheapplicantunderstandtheymustholdaWisconsinSeller’sPermit?
[phone(608)266-2776] .......................................................................................... Yes No
14. DoestheapplicantunderstandthattheymustpurchasealcoholbeveragesonlyfromWisconsinwholesalers,breweriesandbrewpubs? .. Yes No
Original Alcohol Beverage Retail License Application
Submit to municipal clerk.
READ CAREFULLY BEFORE SIGNING: Underpenaltyprovidedbylaw,theapplicantstatesthateachoftheabovequestionshasbeentruthfullyansweredtothebestofthe
knowledgeofthesigner.Anypersonwhoknowinglyprovidesmateriallyfalseinformationonthisapplicationmayberequiredtoforfeitnotmorethan$1,000.Signeragreestooperate
thisbusinessaccordingtolawandthattherightsandresponsibilitiesconferredbythelicense(s),ifgranted,willnotbeassignedtoanother.(Individualapplicants,oronememberof
apartnershipapplicantmustsign;onecorporateofcer,onemember/managerofLimitedLiabilityCompaniesmustsign.)Anylackofaccesstoanyportionofalicensedpremises
duringinspectionwillbedeemedarefusaltopermitinspection.Suchrefusalisamisdemeanorandgroundsforrevocationofthislicense.
For the license period beginning 20 ;
ending 20
Town of
TO THE GOVERNING BODY of the:
Village of
City of
County of Aldermanic Dist. No.
(if required by ordinance)
}
(Officer of Corporation / Member / Manager of Limited Liability Company / Partner / Individual)
Wisconsin Department of RevenueAT-106 (R. 7-18)
TO BE COMPLETED BY CLERK
Applicant’s WI Seller’s Permit No.:
FEIN Number:
LICENSE REQUESTED
FEE
Class A beer $
TOTAL FEE $
TYPE
Class B beer $
Class C wine $
Class A liquor $
Class A liquor (cider only) $
Class B liquor $
Reserve Class B liquor $
Class B (wine only) winery $
Publication fee $
N/A
Date received and led with municipal clerk
Date license granted
Date reported to council / board Date provisional license issued
Date license issued License number issued
Signature of Clerk / Deputy Clerk
FYI - click mouse in 'For the license period beginning' field to begin and tab
throughout. Use mouse to check appropriate boxes, spacebar or enter.
Save
Print
Clear
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Original Alcohol Beverage Retail License Application (Village of Mount Pleasant)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 14 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document