Liquor License Application Form
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4Premises File Number: _______________
Idaho State Police
Alcohol Beverage Control Bureau
License Number: ___________________
700 S. Stratford Dr. Ste 115
Opening Date: _____________________
Meridian, ID 83642
Phone (208) 884-7060 Fax (208) 884-7096
See Instruction Sheet
Liquor License Application
1. Application Type
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New
Transfer [
Applicant □ Location]
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Change Current Application [ □ ‘Doing Business As’ Name (See #3) □ Floor Plan □ License Types (See #2)]
2. License Type and Fees
See Instruction Sheet for Fees
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Total Fees: ___________
Beer $50.00
Growlers $0.00
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Wine by the Bottle - Included
On-Premises Consumption $0.00
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Wine by the Glass - Included
Restaurant $0.00
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Keg Beer to Go $20.00
Multi-Purpose Arena Endorsement $0.00
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Liquor by the Drink: $________________
This place of business is applying for an incorporated city liquor-by-the-drink license, OR per Idaho Code Title
23 Chapter 9 an exception, as listed:
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Airport Restaurant
Railroad
Equestrian Facility
Split Ownership
Facility
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Theme Park
Club
Airline
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Rural Lodging Facility
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Racing Facility
Common Carrier Boat
X-Country Ski Resort
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Indian Tribe
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Year Round Resort
Gondola
Golf Course
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Resort City
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Ski Resort
Continuous Operation
Waterfront Resort
Facility
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Convention Center
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This business is located
inside or
outside city limits.
3. Applicant Information
A. Applicant Name: ________________________________________________________________________________
(Individual, Corporation, LLC, Partnership or other business entity)
‘Doing Business As’ Name: ___________________________________ Business Phone No.: __________________
Business Physical Address: ____________________________________________________________________________
City: _______________________________ County: ____________________________ Zip: ______________________
Mailing Address: ____________________________________________________________________________________
(Include City, State, Zip)
Alternative Phone No.: ______________________________ E-Mail Address: __________________________________
Former Business Name (Transfers Only): ________________________________________________________________
B. Applicant’s Idaho State Tax Commission Seller’s Permit Number: _____________________________________
C. Applicant’s Financial Information
Business Bank Name and Address (Branch): ______________________________________________________________
Persons Authorized to Sign on Account: ___________________________________ Title: _______________________
D. Type of Liquor License Transfer Information: Attach Documentation of Transfer – See Instruction Sheet
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Leased
New Offer: _______________________________________________________________
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Purchased – Purchase Price paid: _______________________________
4. List sole proprietor(s) or all partners, corporate officers, directors, ten primary stockholders,
LLC/LLP members/partners of the applicant.
Attach a separate sheet of paper following the format below.
Name: ______________________________________ Address: __________________________________________
Title: _____________________ SSN: ______________________________ Date of Birth: ____________________
Idaho Resident: (Y/N) _________________________ If ‘YES’ length of residency: __________________________
EH 10.02-01 Liquor Application
Page 1 of 4
Rev. 07/2015
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