____________________________________________________
____________________________________________________
MANAGER OF LICENSED PREMISES:
NAME_______________________________________________ DATE OF BIRTH_________________
HOME ADDRESS_________________________________________________ZIP CODE____________
(MUST RESIDE WITHIN DECATUR CITY LIMITS & PROVIDE COPY OF VALID ILLINOIS DRIVER’S
LICENSE OR STATE ID) Illinois Liquor Control Act of 1934, Sec. 5/6-2, Person Ineligible to be
Licensed: A person who is not a resident of any City in which the premises covered by license are located.
TELEPHONE NUMBER____________________EMAIL ADDRESS______________________________
OWNER OF RECORD OF PREMISES TO BE LICENSED:
NAME_____________________________________________________________________________
ADDRESS (INCLUDE CITY & ZIP CODE) ___________________________________________________
TELEPHONE NUMBER________________________
AFFIDAVIT OF PARTNERSHIP APPLICANT
ON OATH, I HEREBY STATE AND AVER, THAT:
1) The facts asserted in the foregoing application for a liquor license are true, on information and belief.
2) The undersigned partner in the business, has authority to bind the partnership.
3) No law enforcing public official, Mayor or member of the City Council is interested in any way directly
in the partnership or the business to be licensed.
4) That I am qualified, as required by law and ordinance, for issuance of a liquor license.
5) The manager’s affidavit and affidavits of all partners of said partnership are attached.
6) The partnership is not indebted to the State of Illinois or the City of Decatur, Illinois.
7) The partnership has not had its liquor license revoked for cause.
8) I have not been convicted of a felony under any Federal or State law, convicted of keeping a place of prosti-
tution or keeping a place of juvenile prostitution, or convicted of pandering or other crime or misdemeanor opposed to
decency and morality, such that I am ineligible to receive a license under the provisions of the Illinois Liquor Control
Act of 1934, as amended.
Print Name: ___________________________________________
Title: ________________________________________________
Signature
Signature must be notarized before returning this form to the City Clerk’s office.
Date
STATE OF ILLINOIS )
)SS
COUNTY OF MACON)
SUBSCRIBED AND SWORN TO BEFORE ME THIS ____ DAY OF _______________, ________
(SEAL) ________________________________________
NOTARY PUBLIC
