Form B-0188 - Application For Permit To Sell Alcoholic Beverages (Page 2 of 3) in pdf

5. Give the names and addresses of all persons related to you or principles of applicant by blood, marriage, or otherwise

(including yourself) who own, operate, or have any direct or indirect interest in a licensed Retail Liquor Store, Retail

Food Store, Wholesale Distributor, Distillery, Supplier or Liquor-By-the-Drink? Please provide details related to the

name and nature of the business. _______________________________________________________________________

__________________________________________________________________________________________________

6. Give the names and addresses of all persons, other than those shown on this application, who have any direct or indirect

interest, e.g. financial, stock ownership, loans, gifts, or securing loans, or otherwise, provided on applicant’s behalf for

carrying on said business. ____________________________________________________________________________

__________________________________________________________________________________________________

7. Do you own or operate a liquor-by-the-drink establishment? _______ If so, is it separate from the retail food store ______

8. Give the names and addresses of all persons, other than those shown on the application, who share in the profits from this

business and state their interest. ________________________________________________________________________

9. Give the name and address of the owner of the premises on which the business is to be located and the amount of the rent.

Submit a copy of all leases, sub-leases and/or assignments entered into for this applicant. __________________________

__________________________________________________________________________________________________

10. Do you sub-lease, franchise or otherwise permit any person to occupy any of the space covered in this lease? ________

If so, state the name of the person(s) and the type(s) of business(es) being operated _______________________________

__________________________________________________________________________________________________

11. Please identify by name and manager permit number all certified and designated managers ______________________

__________________________________________________________________________________________________

12. Are all clerks responsible for the sales of wine certified pursuant to a Responsible Vendor Training Program? _______

13. Give the name(s) and address(es) of other business(es) in which applicant or principles of applicant are engaged. ____

_________________________________________________________________________________________________

14. Do you agree to accept full responsibility for the action of any member or principal of the applicant or any person

employed by applicant in the conduct of applicant’s business? _______________________________________________

15. If this an application for a renewal license, state whether you received any additional or new financial assistance, loans,

or otherwise, during the previous year? __________________________________________________________________

16. If the answer to question 16 is “yes”, state all facts and details in connection with said financial assistance, loans,

etc._______________________________________________________________________________________________

__________________________________________________________________________________________________

17. If you are indebted to the State of Tennessee for any tax, state the tax and amount. _____________________________

18. Furnish Tennessee Sales Tax Registration Number ______________________________________________________

19. Give name and address of any relative employed by the Tennessee Alcoholic Beverage Commission. ______________

__________________________________________________________________________________________________

20. Is the proposed location for the retail food store located in a municipality or county which has approved sales of wine

by retail food stores by local option p

§ 57-3-106? _________________________________________________

ursuant to

21. Does applicant derive at least twenty percent (20%) of its sales taxable sales from food and food ingredients for human

consumption? ______________________________________________________________________________________

22. Does the establishment have at least one thousand two hundred (1200) square feet of retail floor space? ____________

AB-0188

RDA 2261

Form B-0188 - Application For Permit To Sell Alcoholic Beverages Page 2