Uniform Alcoholic Beverage License Application
A. Owner Name and Address
Owner’s Telephone #: ____________________________________
C. Indicate the class of license being applied for
(submit separate application for each class of license).
Retail (on-sale) Liquor
Retail (on-sale) Liquor - Restaurant
Convention Center (on-sale) Liquor
Package (off-sale)
Retail (on-off sale) Wine and Cider
Retail (on-off sale) Malt Beverage & SD Farm Wine
Package Delivery
Hunting Preserve
License No.__________________________
Date Received_______________________
Date Issued_________________________
(State Use)
tax approval_________________
Date _______________
G. CERTIFICATE: The undersigned applicant certifies under the penalties of perjury that all statements provided herein are
true and correct; that the said applicant complies with all of the statutory requirements for the class of license being applied
for and in addition agrees to permit agents of the Department of Revenue access to the licensed premises and records as
provided in SDCL 35-2-2.1, and agrees this application shall constitute a contract between applicant and the State of South
Dakota entitling the same or any peace officers to inspect the premises, books and records at any time for the purpose of
enforcing the provisions of Title 35 SDCL, as amended.
Print Name
H. APPROVAL OF LOCAL GOVERNING BODY Notice of hearing was published on ____________________. Public
hearing on the application was held ____________________, not less than SEVEN (7) days after official publication. The
governing body by majority vote recommends the approval and granting of this license and certifies that requirements as to
location and suitability of premises and applicant have been reviewed and conform to the requirements of local and South
Dakota law.
Renewal - no public hearing held
Amount of fee collected with application $_____________
Amount of fee retained $___________________________
Forwarded with application $ _______________________
For Local Government Use
(Seal) _______________________________________
Mayor or Chairman
If disapproved, endorse reason thereon and return to applicant
Is this license in active use? [ ] Yes [ ] No
Do you or any officers, directors, partners, or stockholders
hold any other alcohol retail, manufacturing, or
wholesaler licenses?
[ ] Yes [ ] No If Yes, please list on the back page.
B. Business Name and Address
Business Telephone #: ______________________________
Place of business is located in a municipality? [ ] Yes [ ] No
Do you own or lease this property? [ ] Own [ ] Lease
Are real property taxes paid to date? [ ] Yes [ ] No
D. Legal description of licensed premise:
Have you ever been convicted of a felony? [ ] Yes [ ] No
E. State Sales Tax Number
F. New license_____Transfer? ($150)_____ Re-issuance____
Please complete the reverse side if applicable
Company supplement information
(For corporate/partnership/LP/LLC applicants)
Name of corporation/partnership/LP LLC _____________________________________________________________________
Address of office and principal place of business of corporation/partnership/LP/LLC_____________________________________
Are all managing officers of this corporation/partnership/LP/LLC of good moral character having never been convicted of
a felony? [ ] Yes [ ] No
Name, title of office, occupation and address of each of the officers/owners of the corporation, partnership, LP or LLC:
Name of any officers, directors, partners or stockholders of applicant having a financial interest or capital stock in any other alcoholic
beverage license:
Type of License, License Number, Financial Interest Held, and Address of Business Location
Where and with whom are all company records kept, such as charter, by-laws, minutes, accounts, notes payable, and notes and
accounts receivable, etc?
With signature the applicant agrees to the following:
That the applicant company will comply with all provisions of ARSD chapter No. 64:75:02 of the Department of Revenue,
relating to the transfer of stock and prior approval of the transfer of such stock by the Secretary of Revenue and violation of any of
the provisions of said regulation or failure to comply therewith, whether by the undersigned corporation, partnership/LP/LLC or by
any stockholder thereof, or by anyone interested in said company, shall constitute cause for revocation or suspension of any license
issued pursuant to and in reliance on this application, or for refusal to renew such license upon expiration thereof.
We the undersigned officers and directors of the applicant company acknowledge that the within supplement application form is
true and correct in every respect and that there exists no financial arrangement concerning this or any other alcoholic beverage
license than that expressly set forth above. If company stock is to be transferred we ask for approval of such voluntary stock
Signature of Authorized Officer/Director/Partner