New Alcoholic Beverage Retailers Permit Application
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13PERMIT NUMBER_________
APPLICATION, NEW
ALCOHOLIC BEVERAGE RETAILERS PERMIT
I.
APPLICANT _______________________________________________
(name of sole owner, partnership, or corporation)
Trade Name _______________________________________________
Mailing Address _____________________________________________
(street/p.o. box)
(city)
(state)
(zip)
Location of business _________________________________________
(street)
(city)
(zip)
This location is _ inside _ outside the corporate city limits.
Include a copy of the lease or deed to the business premises and a floor plan of the
premises (see instructions).
Telephone number
______________
_______________
(business)
(home)
II.
PERMIT TYPE
FEE AMOUNT
Manufacturer Class I, Distiller &/or Rectifier .............................
(
)
$9,025.00
Manufacturer Class II, Wine ...................................................
(
)
3,625.00
Manufacturer Class III, Native Wine ........................................
(
)
45.00
Package retailer .....................................................................
(
)
1,825.00
On-premises retailer ...............................................................
(
)
925.00
On-premises retailer, Club ......................................................
(
)
475.00
On-premises retailer, Wine only ..............................................
(
)
475.00
Common carrier .....................................................................
(
)
120.00
Native wine retailer .................................................................
(
)
125.00
Caterer’s permit, for on-premises retailers ................................
(
)
325.00
Caterer’s permit ......................................................................
(
)
1,225.00
Solicitor .................................................................................
(
)
125.00
Research ...............................................................................
(
)
125.00
III.
TYPE OF ORGANIZATION
(
) Sole ownership
(
) Partnership
(
) Corporation
(
) Trust
(
) Other _________________________________
IV.
Does the applicant have, or has the applicant ever had, an interest in any
other alcoholic beverage retailers permit? ________________ If "yes",
explain fully: _______________________________________________
__________________________________________________________
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