Form Wld-031 - For Liquor, County Malt Beverage, Limited, Winery Or Microbrewery (Page 4 of 4) in pdf

OATH OR VERIFICATION

(Requires signatures by ALL Individuals, ALL Partners, TWO (2) LLC Members, or TWO (2) Corporate

Officers/Directors,

or TWO (2) Club Officers.) W.S. 12-4-102(b)

Under penalty of perjury, and the possible revocation or cancellation of the license, I swear the above stated facts, are true and

accurate.

STATE OF WYOMING )

SS.

COUNTY OF _________)

Before Me, ___________________________________________________________________, (specify) a Notary Public, Officer authorized

(Printed name of Notary or other officer authorized to administer oaths)

to administer oaths in and for__________________________________________________County, State of Wyoming, personally appeared

________________________________________________________name he/she being first duly sworn by me upon his oath, says that the

(Insert Names)

facts alleged in the foregoing instrument are true.

(Seal)

1.__________________________________________________

2.__________________________________________________

3.__________________________________________________

My Commission expires: _____________________

4.__________________________________________________

Witness my hand and official seal:

__________________________________________

(Notary Public or other officer authorized to administer oaths)

Title ______________________________________

Dated: ______________________________________

REQUIRED ATTACHMENTS

(1)

Attach any lease agreements W.S. 12-4-103(a)(iii).

(2)

If building is not in existence, an architect's drawing or suitable plans of the room and premises to be licensed must be attached W.S. 12-4-102(a)(i).

(3)

A statement indicating the financial condition and financial stability of new applicant W.S. 12-4-102(a)(v).

(4)

Restaurant Liquor License Applications must attach a copy of their CURRENT and valid food service permit W.S. 12-4-407(a).

(5)

Check or bank draft as payment for the application and for publishing the notice of application. W.S. 12-4-104(a). Direct billing is permissible.

(6) If transfer, a form of assignment from current licensee, allowing transfer W.S. 12-4-601(b).

NOTE: Federal law requires you to pay a SPECIAL OCCUPATIONAL TAX (federal tax stamp) before you begin business and before July 1

each year thereafter. If you have not paid this tax, contact:

BUREAU OF ATF

JOHN WELD PECK FEDERAL BLDG RM 6525

550 MAIN ST

CINCINNATI OH 45202-3263

1-800-937-8864

ADVERTISING REQUIREMENTS W.S. 12-4-104(a):

When an application for a license, permit, renewal or any transfer of location or ownership thereof has been filed with a licensing authority, the clerk

shall promptly prepare a notice of application, place the notice conspicuously upon the premises shown by the application as the proposed place of

sale and public the notice in a newspaper of local circulation once a week for four (4) consecutive weeks. The notice shall state that a named applicant

has applied for a license, permit, renewal or transfer thereof, and that protests against the issuance, renewal, or transfer of the license or permit will be

heard at a designated meeting of the licensing authority.

HEARING REQUIREMENTS W.S. 12-4-104(b):

Any license or permit authorized under this title shall not be issued, renewed or transferred until on or after the date set in the notice for hearing

protests. If a renewal hearing, the hearing shall be held no later than thirty (30) days preceding the expiration date of the license or permit. A license

or permit shall not be issued, renewed or transferred if the licensing authority finds from evidence presented at the hearing:

(i)

The welfare of the people residing in the vicinity of the proposed license or permit premises shall be adversely and seriously affected;

(ii) The purpose of this title shall not be carried out by the issuance, renewal or transfer of the license or permit;

(iii) The number, type and location of existing licenses or permits meets the needs of the vicinity under consideration;

(iv) The desires of the residents of the county, city or town will no be met or satisfied by the issuance, renewal or transfer of the license or permit; or

(v) Any other reasonable restrictions or standards which may be imposed by the licensing authority shall not be carried out by the issuance, renewal

or transfer of the license or permit.

FOR LIQUOR DIVISION USE ONLY

Reviewer

Initials

Date

Clerk:

Agent:

Acct.: