Form Wld-031 - For Liquor, County Malt Beverage, Limited, Winery Or Microbrewery Page 3
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414. SOCIAL CLUBS W.S. 12-1-101(a)(iii)(E):
(a) Do you have more than one hundred (100) bona fide members who are residents of the county in which the club is
located?
YES
NO
(b) Is the club incorporated and operating solely as a nonprofit organization under the laws of this state?
YES
NO
(c) Is the club qualified as a tax exempt organization under the Internal Revenue Service?
YES
NO
(d) Has the club been in continuous operation for a period of not less than one (1) year?
YES
NO
(e) Has the club received twenty-five dollars ($25.00) from each bona fide member as recorded by the secretary of the
club and are club members at the time of this application in good standing by having paid at least one (1) full year in
dues?
YES
NO
(f) Does the club hold quarterly meetings and have an actively engaged membership carrying out the objectives of the
club?
YES
NO
(g) Have you filed a true copy of your bylaws with the local licensing authority and the Wyoming Liquor Division?
YES
NO
(h) Has at least fifty one percent (51%) of the membership signed a petition indicating a desire to secure a Limited
Retail Liquor License (THE PETITION MUST BE ATTACHED TO APPLICATION) ?
YES
NO
(i) Have you filed with the licensing authority and the Wyoming Liquor Division a detailed statement of your activities
during the preceding year which were undertaken or furthered in pursuit of the objectives of the club, along with an
itemized statement expended for such activities?
YES
NO
15. GOLF CLUBS W.S. 12-1-101(a)(iii)(D):
(a) Do you have more than fifty (50) bona fide members?
YES
NO
(b) Do you own, maintain, or operate a bona fide golf course together with clubhouse?
YES
NO
16. (a) If applicant is an Individual or Partnership: State the date of birth and residence of each applicant or partner, if the
application if made by more than one individual or by a partnership: W.S. 12-4-102(a)(ii)
DONOT LIST
Have you been a
Have you been
PO BOXES
DOMICILED resident for
Have you
Convicted of a
at least 1 year and not
been
Violation Relating
Residence
claimed residence in any
Convicted of
to Alcoholic
Residence Address No. &
Date of
Phone
other state
a Felony
Liquor or Malt
Street
True and Correct Name
Birth
City, State & Zip
Number
in the last year?
Violation?
Beverages?
YES
YES
YES
NO
NO
NO
YES
YES
YES
NO
NO
NO
YES
YES
YES
NO
NO
NO
YES
YES
YES
NO
NO
NO
YES
YES
YES
NO
NO
NO
(If more information is required, list on a separate piece of paper and attach to this application.)
(b) If the applicant is a Corporation: State the name, date of birth and residence of each officer, director and stockholder
holding, either jointly or severally, ten percent (10%) or more of the outstanding and issued capital stock of the corporation;
If the applicant is a Limited Liability Company W.S. 12-4-102(a)(v): state name, age and residence of each officer,
manager and member holding, either jointly or severally, ten percent (10%) or more of the outstanding ownership of the
limited liability company. W.S. 12-4-102(a)(iv)
DONOT LIST
Have you been
PO BOXES
Have you
Convicted of a
No. of
been
Violation Relating
Residence Address No. &
Residence
Years in
Convicted of
to Alcoholic
Date of
Street
Phone
Corp or
% of Stock
a Felony
Liquor or Malt
True and Correct Name
Birth
Number
LLC
Held
Violation?
Beverages?
City, State & Zip
YES
YES
NO
NO
YES
YES
NO
NO
YES
YES
NO
NO
YES
YES
NO
NO
YES
YES
NO
NO
(If more information is required, list on a separate piece of paper and attach to this application.)
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