Fillable TULALIP LIQUOR REGULATIONS BEER/WINE APPLICATION (The Tulalip Tribes)

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TULALIP LIQUOR REGULATIONS BEER/WINE APPLICATION (The Tulalip Tribes)

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  • 11 check-boxes
  • 141 other fields

Country of origin: US
File type: PDF

U.S.A. forms for The Tulalip Tribes

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TULALIP LIQUOR REGULATIONS
BEER/WINE APPLICATION
A. This is a:
_____ New Account _____ Merger Federal Identification
_____ Reopen _____ Reorganization NO.: ________________
_____ Additional _____ Change in Ownership
Location _____ Other (Identify) Opening Date on Res.:
_________________________ _____________________
B. Type of Organization:
_____ Sole Proprietorship _____ Corporation
_____ Partnership
_____ Other (specify)
______________________
C. Name of Proprietor, Partnership, or Corporation:
(Last Name First)
_________________________________________________ __________________________
Business Name Social Security Number
_________________________________________________ ______ _________ ___________
Mailing Address (street or Route No.) City ST. Zip Code Telephone #
_________________________________________________ ______ _________ ___________
Business Location (street or Route No.) City ST. Zip Code Telephone #
Operated By
______ Husband & Wife ____________________ ____________________________
Name of Spouse Social Security No.
_______________________________ _________________ ____________________________
Name of Partner or Title Residence Address
Corporate Officer
______________________________ ____________________________
Telephone Number Social Security Number
_______________________________ _________________ ____________________________
Name of Partner or Title Residence Address
Corporate Officer
______________________________ ____________________________
Telephone Number Social Security Number
_______________________________ _________________ ____________________________
Name of Partner or Title Residence Address
Page 1 of 5
Corporate Officer
Page 2 of 5
______________________________ ____________________________
Telephone Number Social Security Number
D. Liquor Licenses:
_____________________________________________________________________________________
Name of Proprietor, Partnership, or Corporation (Last Name First)
Furnish to your enforcement officer drawings or sketches, in duplicate, of the floor plans of the
premises to be licensed, drawn one-fourth inch to one-foot scale. This should show doors, windows,
interior walls, restrooms, stairways, dance floors, and arrangement of furnishings. If the building or
business presently exists, include snapshots of the interior and exterior of the facility to be licensed.
1. Premises located: ____ inside the reservation boundaries _______________ (Zip Code)
____ outside the reservation boundaries _______________ (Zip Code)
2. Owner of building: __________________________ ___________________________________
Name Address
3. Landlord: ________________________ ___________________________________
Name Address
4. Lease: Date ________________ Expires ____________________ Rental _______________
5. Owner of furniture,
fixtures or equipment: _________________________ ____________________________
Name Address
6. Owner of all coin-
operated machines: _________________________ ____________________________
Name Address
7. Have you any interest, financial or otherwise, in any manufacturer or wholesaler of liquor?
______________. If married, is either spouse employed by any manufacturer or wholesaler of
liquor? ______________. Has any manufacturer or wholesaler of liquor any interest on you
business? ______________.
8. Holder of contract or encumbrance on furniture, fixtures, or equipment:
_____________________ _____________________________ ______________
Name Address Amount
9. Is any person other than the applicant to share in the profits or losses of you business? _________
____________________________ ______________________________________________
Name Address
10. Has any person, other than those named in the foregoing answers, any financial interest in your
business? ___________
____________________________ __________________________________________
Name Address
11. Has any person, firm or organization loaned or advanced money or property for the acquisition or
operation of you business? ________________________________________________________
______________________________________________________________________________
(Attach Additional Statement if Necessary)
Page 3 of 5
12. (a) What is your principal business at these premises? __________________________________
What other business, if any, is conducted on these premises:
______________________________________________________________________________
By whom: __________________________________________________________________
(b) What other business, if any do you conduct elsewhere? ______________________________
13. What percent of your business is derived from the sale of liquor? _____________ %
14. Give numbers on you federal, state or tribal wholesale and/or retail permits: _________________
15. Has applicant been previously licensed by the Tulalip Liquor Commission? _________________
Give latest year and location: ______________________________________________________
Has license ever been denied? ______ Suspended? ______ Canceled? _________
16. Has this location been previously licensed? ___________________________________________
17. What is your approximate business investment? _______________________________________
18. If applicant is an individual, answer the following questions
(if married, answer each question for
both husband and wife):
(a) Date of Birth: ____________________________ ____________________________
Husband Wife
Soc. Sec. No. _____________________________ ____________________________
Husband Wife
(b) Member of the Tulalip Tribes? If no, give affiliation.
______________________________ ___________________________________
Husband Wife
(c) Have you resided on the Tulalip reservation for at least one-year prior to filing application?
__________________________
(d) Give occupation for at least three years: _________________________________________
(e) Have you ever been arrested, pleaded guilty, or forfeited bond or been convicted of any crime
whatsoever (Tribal ordinances, Federal or State laws, including any traffic violations involving
intoxicating liquor)? If so, state nature of charge, date in what court and please pleaded guilty,
forfeited or convicted, and penalty:
Husband ______________________________________________________________________
Wife _________________________________________________________________________
Page 4 of 5
19. If applicant is a partnership
, answer the following questions: (if any partner is married, answer
each question for both husband and wife).
Date of
Soc.Sec.
Name
Birth Number
(a) Who are the Partners:
Husband ____________________ ___________________ ______________
Wife ____________________ ___________________ ______________
Husband ____________________ ___________________ ______________
Wife ____________________ ___________________ ______________
Husband ____________________ ___________________ ______________
Wife ____________________ ___________________ ______________
(b) When was partnership business started: __________________________________________
(c) Are all partners and spouses members of the Tulalip Tribes of WA.? ___________________
(d) Are all partners and spouses resided in this state at least one month prior to filing this
application? If not, state particulars: ________________________________________________
______________________________________________________________________________
(e) Has any partner or spouse been arrested, pleaded guilty, forfeited bond or been convicted or any
crime whatsoever (Tribal ordinances, Federal or State laws, including any traffic violations
involving intoxicating liquor)? ________________. If so, state nature of charge, date, in what
court and place pleaded guilty, forfeited or convicted, and penalty: ________________________
______________________________________________________________________________
(Attach additional statement, if necessary, to describe in detail)
20. If applicant is a
corporation
, answer the following, and questions below relating to manage
(NOTE: Corporation must be registered with the Secretary of State’s Office in Olympia and/or
the Tulalip Tribes of Washington:
(a) When were you incorporated: ____________________ Where: _____________________
(b) Officers: Name
Date of Social Security
Birth
Number
___________________________ _______________ _____________________
___________________________ _______________ _____________________
___________________________ _______________ _____________________
Page 5 of 5
(c) Are all officers and directors members of the Tulalip Tribes of Washington? _____________
If not, indicate which ones and state their citizenship and tribal affiliate: ___________________
______________________________________________________________________________
(d) Has any officer been arrested, pleaded guilty, forfeited bond or been convicted of any crime
whatsoever (Tribal ordinances, Federal or State laws, including any traffic violations involving
intoxicating liquor)? _____________. If so, state nature of charge, date, in what court and place
pleaded guilty, forfeited or convicted, and penalty: _____________________________________
______________________________________________________________________________
(Attach Additional Statements, if necessary, to describe in detail)
21. If business is to be conducted by a
manager
, answer the following questions:
(a) Name of Manager: _______________________ Date of Birth: _______________________
(b) Citizen of the United States? _____ If not, give citizenship: _________________________
Member of the Tulalip Tribes: _____ If not, give tribal affiliation: _____________________
(c) Has he resided in this state at least one month prior to filing this application? ____________
(d) Has he been arrested, pleaded guilty, forfeited bond or been convicted of any crime
whatsoever (Tribal ordinances, Federal or State laws, including any traffic violations involving
intoxicating liquor)? _____________. If so, state nature of charge, date, in what court and place
pleaded guilty, forfeited or convicted, and penalty: _____________________________________
______________________________________________________________________________
(Attach Additional Statements, if necessary, to describe in detail)
I, _________________________________, declare, under the penalties of perjury and/or the revocation of
any licenses granted pursuant hereto, that I am the applicant or the duly authorized representative of the
firm or corporation making this application and that the answers contained in said application, including
any accompanying information, have been examined by me and that the matters and things set forth therein
are true, correct and complete.
________________________________________________
Applicant - Partner - President - Secretary
__________________________________
Date
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TULALIP LIQUOR REGULATIONS BEERWINE APPLICATION (The Tulalip Tribes)

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Completed 20 July 2020

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