Application For A Beer Permit Form (Page 2 of 2) in pdf

__________________________________________________________________________

11. Give name, date of birth, and address of any manager other than applicant:

__________________________________________________________________________

12. Has any person having at least a 5% ownership interest, any of the managers listed in

question 11, or any other employee of the business, been convicted of any violation of the

laws against possession, sale, manufacture or transportation of beer or other alcoholic

beverages or any crime (other than minor traffic violations) within the last ten years? ______

If so, give details of each charge, court, and date convicted. ___________________________

__________________________________________________________________________

13. Has this owner or the owner's organization had a beer permit revoked, suspended or denied in

the State of Tennessee? Yes ____ No ____. If so, specify where, when and why.

__________________________________________________________________________

14. Give the name, relationship to applicant (if applicable) and address of the former beer

permittee at this location. _____________________________________________________

__________________________________________________________________________

I am knowledgeable of the laws prohibiting the sale of beer to minors. I hereby certify that no

person having at least a 5% ownership interest, nor any person to be employed in the

distribution or sale of beer in my establishment has been convicted of any violation of the beer

or alcoholic beverage laws or any crime involving moral turpitude within the past 10 years. I am

also aware that I shall not be issued a permit or my permit shall be revoked if my business

location causes traffic congestion or interferes with schools, churches, or other places of public

gathering, or otherwise interferes with public health, safety and morals.

_______________________________________________

Signature of Applicant/Owner (or Authorized Corporate Officer)

Sworn to and subscribed before me this ________day of ______________, 20___.

__________________________________ My Commission Expires: _________________

Notary Public

NOTICE: A non-refundable $250 fee must accompany this application. If the application is

approved you are required to provide documentation of sales tax registration to the city within ten

days of approval. Any applicant making a false statement in this application shall forfeit his

permit and shall not be eligible to receive any permit for a period of ten years.

A privilege tax of $100 is imposed on the business of selling, distributing, storing or

manufacturing beer in this state effective January 1, 1994 and each successive January 1. Any

holder of a beer permit issued after January 1, 1994 shall pay a pro rata portion of this annual tax

when the permit is issued.

Application For A Beer Permit Form Page 2