Form At-212 - Application For Vessel Permit - Wisconsin Department Of Revenue Page 2
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4C.
DOES THE APPLICANT, ANY MEMBER OF THE PARTNERSHIP, OFFICER, DIRECTOR, STOCKHOLDER OR AGENT HOLD ANY INTEREST
IN ANY OTHER RETAIL BEER AND/OR LIQUOR LICENSE OR WHOLESALE BEER LICENSE OR LIQUOR PERMIT IN WISCONSIN?
YES
NO
IF YES, IDENTIFY:
NAME
LOCATION
TYPE OF LICENSE
DOES ANY RETAIL ALCOHOLIC BEVERAGE LICENSEE, WHOLESALE BEER LICENSEE OR WHOLESALE LIQUOR PERMITTEE OR ANY
OFFICER, DIRECTOR, STOCKHOLDER OR SUCH PERMITTEE OR LICENSEE HAVE ANY INTEREST IN THIS LICENSE?
YES
NO
IF YES, IDENTIFY:
NAME
LOCATION
TYPE OF LICENSE
D.
RENEWAL APPLICANTS ONLY:
DID THE SALE OF FERMENTED MALT BEVERAGES AND INTOXICATING LIQUORS ON THE VESSEL ACCOUNT FOR LESS THAN 50% OF
THE GROSS RECEIPTS OF ALL THE FOOD AND BEVERAGES SERVED ON THE VESSEL?
YES
NO
DOES THE APPLICANT UNDERSTAND THAT ANY PERMIT ISSUED WILL BE VOID AND SUBJECT TO REVOCATION IF INDEBTED IN
EXCESS OF 15 DAYS FOR FERMENTED MALT BEVERAGES OR 30 DAYS FOR INTOXICATING LIQUORS?
YES
NO
READ CAREFULLY BEFORE SIGNING: Under penalty provided by law, the applicant states that each of the above questions has been
truthfully answered to the best of the knowledge of the signers. Signers agree to operate this business according to law and that the rights
and responsibilities conferred by the permit(s), if granted, will not be assigned to another. (Individual applicants and each member of a
partnership applicant must sign; designated corporate officers must sign.)
SUBSCRIBED AND SWORN TO BEFORE ME
(President of Corp./Partner/Individual)
this
day of
20
(Secretary of Corp./Partner)
(Clerk/Notary Public)
My Commission expires
(Additional Partner(s), If Any)
NOTE:
The annual fee for a Class “B” fermented malt beverage permit for a vessel is $100. An annual fee of $300 is provided for a “Class B”
intoxicating liquor permit. Checks must be made payable to the Wisconsin Department of Revenue. All annual permits expire on June 30.
A valid “Class B” intoxicating liquor permit could not be issued unless the applicant also applies for a Class “B” fermented malt beverage
permit.
The annual liquor permit fee may be prorated if there are 11 months or less remaining in the year.
A permit may be issued at any time for a period of 6 months in any calendar year for which 1/2 of the beer fee and 1/2 of the liquor would
be charged. Such 6 month permit may not be renewed in the same calendar year.
Each individual, each member of a partnership and each officer and director of a corporation applying for a permit to sell alcohol bever-
ages must complete a separate “Auxiliary Questionnaire”.
The schedule for “Appointment of Agent” must be completed and signed by the agent and the president and secretary of a corporation.
The agent must be recommended by the proper municipal officials.
The corporation must notify the department immediately of a change of agent and remit a fee of $10.
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