Form Wld-031 - For Liquor, County Malt Beverage, Limited, Winery Or Microbrewery
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4WLD-031 (4/99)
FOR NEW LICENSES AND TRANSFER
LICENSE AND/OR PERMIT APPLICATION
FOR LIQUOR, COUNTY MALT BEVERAGE, LIMITED, WINERY OR MICROBREWERY
Formerly Held by:
To be completed by the City, Town or County Clerk:
Applicant:
Date Filed:
/
/
Annual Fee
Prorated
Trade Name (dba):
Fee
$
.
$
.
Basic Fee:
Premise:
$
.
$
.
Add’l Dispensing Room
Number & Street
Fee:
$
.
Transfer Fee:
City
State
Zip
County
$
.
$
.
Total License Fee
Collected
Mailing Address:
Publishing Fee Collect:
$
.
Number & Street or P.O. Box
Required Attachments Received:
Yes
City
State
Zip
Advertising Dates(4):
Hearing Date:
/
/
Business Telephone Number: (
)
Local Licensing Number:
Fax Number:
(
)
LICENSING AUTHORITY: Begin publishing promptly. As
E-Mail Address:
W.S. 12-4-104(d) specifies: NO LICENSING AUTHORITY
SHALL APPROVE OR DENY THE APPLICATION UNTIL
For the license term:
THE LIQUOR DIVISION HAS CERTIFIED THE
Month
Day
Year
APPLICATION IS COMPLETE.
A copy must be immediately forwarded to:
Through:
,
Month
Day
Year
State of Wyoming Liquor Division
th
1520 E 5
Street
Cheyenne WY 82002-0110
FILING FOR
TYPE OF LICENSE OR PERMIT
To Assist the Liquor Division with
NEW
(CHOOSE ONLY ONE)
scheduling inspections:
TRANSFER LOCATION
RETAIL LIQUOR LICENSE
TRANSFER OWNERSHIP
on-premise only
DO YOU OPERATE?
off-premise only
combination on/off premise
FULL TIME (e.g. Jan through Dec)
RESTAURANT LIQUOR LICENSE
FILING IN (CHOOSE ONLY ONE)
CITY OF
RESORT LIQUOR LICENSE
SEASONAL/PART-TIME
COUNTY RETAIL or SPECIAL MALT
COUNTY OF
BEVERAGE PERMIT
(specify months of operation)
VETERANS CLUB
FRATERNAL CLUB
from _____________ to _____________
GOLF CLUB
SOCIAL CLUB
DAYS OF WEEK (e.g. Mon through Sat)
FILING AS (CHOOSE ONLY ONE)
MICROBREWERY
INDIVIDUAL
LLC
WINERY
PARTNERSHIP
LLP
HOURS OF OPERATION (e.g. 10a - 2a)
CORPORATION
LTD PARTNERSHIP
ASSOCIATION
LOCATED WITHIN 5 MILES OF
ORGANIZATION
CITY (County License only)
1. Location of License:
(a) Give a description of the dispensing room and state where it is located in the building (e.g. 10x12 room in SE corner
of 1st floor of building). If the building is not in existence, provide the location and an architect's drawing or suitable
plans of the room and premises to be licensed: If Winery or Microbrewery, also list manufacturing facility. W.S. 12-4-
102(a)(i):
(b) Do you have an additional dispensing room?
YES
NO If yes, provide description and location:
(c) Provide the legal description and the zoning of the site where the applicant will conduct business:
2. Do you W.S. 12-4-103 (a) (iii):
(1) OWN the building in which sales room is located?
YES (own)
(2) LEASE the building in which sales room is located?
YES (lease)
(A) DATE lease expires _______________________ located on page_____paragraph_____of lease
document.
(B) Provision for SALE of alcoholic or malt beverages located on page_____paragraph_____of lease
document.
NOTE: Attach a true copy of the lease to application. Lease MUST contain provision for SALE OF ALCOHOLIC or MALT
BEVERAGES and be valid THROUGH the TERM OF THE LICENSE W.S. 12-4-103(a)(iii).
3. Have you already assigned, leased, transferred or do you intend to assign, lease, transfer, contract or in any other manner
agree with any person or firm other than yourself as licensee to operate and assert control or partial control of the license
and the licensed room to carry on the licensed liquor business?
YES
NO
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