Form At-107 - Application For Sports Club Permit For Alcohol Beverage License (Page 2 of 4) in pdf

DOES ANYONE RECEIVE A PERCENTAGE OF THE PROFITS OF THE BAR AS WAGES?

ARE ALL PERSONS SELLING OR SERVING ALCOHOL BEVERAGES EMPLOYES OF THE

CLUB WHOSE SALARIES ARE PAID FROM CLUB ACCOUNTS BY THE CLUB TREASURER?

YES

IF YES, EXPLAIN.

YES

IF NO, EXPLAIN.

DOES THE CLUB LEASE OR ASSIGN THE BAR OPERATION TO ANYONE ELSE?

YES

IF YES, EXPLAIN.

HAS THE CLUB MADE APPLICATION TO ITS MUNICIPAL AUTHORITIES FOR A CLASS “B” FERMENTED MALT BEVERAGE LICENSE?

YES

DATE OF APPLICATION

DATE LICENSE GRANTED

DATE LICENSE DENIED

IF THE MUNICIPALITY HAS NOT OR WILL NOT ISSUE A CLASS “B” FERMENTED MALT BEVERAGE LICENSE TO THE CLUB, EXPLAIN WHY:

DOES THE CLUB HAVE ANY BILLS OF MORE THAN 15 DAYS OUTSTANDING TO ANY BREWER OR BEER WHOLESALER?

YES

DOES THE CLUB HAVE ANY LIQUOR BILL OF MORE THAN 30 DAYS OUTSTANDING TO ANY LIQUOR WHOLESALER?

YES

DO THE OFFICERS OF THE CLUB UNDERSTAND THAT ANY LICENSE ISSUED TO THE CLUB WILL BE VOID AND SUBJECT TO REVOCATION

IF THE CLUB IS INDEBTED IN EXCESS OF 15 DAYS BEYOND THE DATE OF THIS APPLICATION FOR FERMENTED MALT BEVERAGES OR

30 DAYS FOR INTOXICATING LIQUOR?

YES

and

declare under the penalties of law that they are the president and secretary, respectively, of the club named in this application which is

organized solely to engage in the specified sport indicated and that they have read each of the questions on the application and believe

that the answers are true and complete to the best of their knowledge.

SUBSCRIBED AND SWORN TO BEFORE ME

this

day of

President/Member of Limited Liability Company

(Notary Public)

Secretary/Member of Limited Liability Company

My Commission expires

NOTE: The annual fee for a sports club intoxicating liquor permit is $300. Sports Club intoxicating liquor permits are issued for a 2 year

period, therefore $600 is due with the application and upon each renewal of the permit.

To obtain a fermented malt beverage license contact your local municipality. If none is available through your municipality, you can ob-

tain a fermented malt beverage permit through the Department of Revenue for an annual fee of $100 ($200 for the 2-year period).

The fee for a permit for less than 12 months shall be prorated according to the number of months or fraction thereof for which the permit

is issued.

Each officer must complete and sign one of the Auxiliary Questionnaires on page 3. Make additional copies as needed.

The schedule for appointment of Agent, page 4, must be completed and signed by the agent and by the president/member and

secretary/member of the club. The agent must be approved by the proper municipal officials, as indicated on page 4.

The club must notify the department immediately of a change of agent and remit a fee of $10.

Form At-107 - Application For Sports Club Permit For Alcohol Beverage License Page 2

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