Liquor License Application Form printable pdf download

Liquor License Application Form

Liquor

License

Application

240 Water Street.

Room 108 .Henderson

NV .89015

.702-565-2045

! Applicant:

Doing

Business

As:

I-~~rt

Date:

Business Fax:

Business Address:

Street:

Mailing Address:

Street:

City, State, Zip:

Type Of Business:

Sole Proprietor

General Partnership

Limited Partnership

-Limited

Liability

Company

D C-Corporation

D S-Corporation

-~ List the names of all persons having an interest in this business either as a sole owner, partner,

joint

venture participant,

or the main officers of a corporation:

Name:

I Title:

Social Security Number

Home Phone Number

Zip:

Home Address:

City:

State:

Home Phone Number

Name:

Title:

Social Security Number

Home Address:

State:

Zip:

Title:

Social Security Number

l~ame:

Home Phone Number

Home Address:

City:

State:

Zip:

ALL NAMES LISTED ON THIS APPLICATION MUST BE PROCESSED BY THE

CITY OF HENDERSON, POLICE DEPARTMENT

Premises Owner:

City, State and Zip

Hotel

Liquor

D Import/Wholesale

Non-restricted

Gaming

Package

Beer

Wine

Package

Liquor

-Retail

Store

Package

Liquor

-Retail

Outlet

Package

Liquor

(Addition*)

Recreation

Club

Beer

& Wine

D Recreation Club Full Liquor

Restaurant

Beer

Wine

Restaurant

Full

Liquor

Restaurant

with

Bar

D Tavern

Supper

Club

* Can only be issued to a tavern, limited gaming liquor, hotel or non-restricted gaming liquor location.

laws of the United States pertaining to the sale of liquor, the State of Nevada, and the ordinances of the City of

Henderson, applicable to the conduct of such business, and that such application is made upon the express

condition that if such license be granted it shall be subject to revocation in accordance with the provisions of the

ordinance.

Signature of Applicant:

Date:

Liquor License Application Form

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