Application For A Beer Permit Form

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APPLICATION FOR A BEER PERMIT
STATE OF TENNESSEE
CITY OF LOUDON
Application for (check one):
______ ON PREMISES PERMIT
______ OFF PREMISES PERMIT
______ ON AND OFF PREMISES PERMIT
I, HEREBY MAKE APPLICATION FOR A PERMIT TO SELL, STORE, MANUFACTURE,
OR DISTRIBUTE BEER OR OTHER BEVERAGES AUTHORIZED TO BE SOLD, STORED,
MANUFACTURED OR DISTRIBUTED UNDER THE PROVISIONS OF TENNESSEE CODE
ANNOTATED SECTION 57-5-101 ET SEQ. AND BASE MY APPLICATION UPON THE
ANSWERS TO FOLLOWING QUESTIONS:
1. Full name of applicant (owner). _________________________________________________
__________________________________________________________________________
Person ____ Firm ____ Corporation ____ Joint-stock co. ____ Syndicate ____ Assn _____
2. List all persons, firms, corporations, joint-stock companies, syndicates or associations having
at least a 5% ownership interest in the business (attach additional sheet, if needed).
__________________________________________________________________________
__________________________________________________________________________
3. What is your present home address? _____________________________________________
__________________________________________________________________________
4. Previous address(es) within the last 10 years. ______________________________________
__________________________________________________________________________
5. Date of birth ____________
Home telephone _________________
Business telephone _____________ Fax Number_________________
e-mail address _____________________________________________
6. Under what name will this business operate? ______________________________________
__________________________________________________________________________
7. Location of business by street address or other geographical description and phone number of
the business. _______________________________________________________________
__________________________________________________________________________
8. Specify the identity and address of the person to receive annual privilege tax notices and any
other communication from the City. _____________________________________________
__________________________________________________________________________
9. Give name and address of property owner, if other than business owner. _________________
__________________________________________________________________________
10. Will permit be used to operate two or more restaurants or other businesses under the same
permit as permitted by Section 57-5-103(a)(4) within the same building? Yes ___ No ___. If
so, specify number _____. List the names of the restaurants or other businesses and describe
their locations.(use additional sheet if necessary) ___________________________________

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