Unlicensed Business Establishment Application For Exemption - Arizona Department Of Liquor Licenses And Control
Download a blank fillable Unlicensed Business Establishment Application For Exemption - Arizona Department Of Liquor Licenses And Control in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Unlicensed Business Establishment Application For Exemption - Arizona Department Of Liquor Licenses And Control with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1FOR DLLC USE ONLY
License #:
Arizona Department of Liquor Licenses and Control
Expiration Date:
800 W Washington 5th Floor
Phoenix, AZ 85007-2934
CSR:
(602) 542-5141
Log #
UNLICENSED BUSINESS ESTABLISHMENT APPLICATION FOR EXEMPTION
This exemption allows customers to bring limited amounts of their own liquor on to the premises to drink.
This application, if approved, is valid for 12 months (1 year) from the date of approval. A new application for exemption must be
submitted each year. A NON-REFUNDABLE $50 FEE WILL APPLY with each application. For uninterrupted exempt status, submit a
new application prior to expiration.
I, _________________________________________, doing business as ________________________________________________________
Owner’s Name
Name of Business
Located at: _________________________________________________________________________________________________________
Establishment’s Street Address
City
County
Zip Code
______________________________________________________
___________________________________________________
Daytime Phone Number
Applicant's Email Address
Is this your first Unlicensed Exemption?
Yes
No
if no, when does your exemption expire?
______/______/______
Hereby request permission from the Department of Liquor to allow my patrons to consume authorized liquor on my
unlicensed premises. I have received and read Arizona statute A.R.S. §4-244.05 and regulation A.A.C. R19-1-324. I declare
that my business qualifies for exemption under A.A.C. R19-1-324 as a:
Small Restaurant (50 seats or less, allowing alcohol consumption from between Noon-10:00 p.m. and shall not allow a patron
to possess or consume more than
forty ounces of beer, 750 ml of wine or four ounces of distilled spirits per visit.
Association/Business Hosting a Private Function (does not exceed the 300 member/patrons, allowing alcohol consumption
between 4:00 p.m.-2:00 a.m. and shall not allow a patron to possess or consume more than
forty ounces of beer, 750 ml of
wine or four ounces of distilled spirits per visit.
I hereby agree to comply with Arizona statute A.R.S. §4-244.05 and regulation A.A.C. R19-1-324 while conducting
business at this location.
I understand that any violations of these rules may result in a fine & civil penalty authorized in A.R.S. §4-244.05(A) and (C).
NOTARY
I,
,
hereby declare that I am a CONTROLLING PERSON/ AGENT filing
(Print Full Name)
this notification. I have read this document and the contents and all statements are true, correct and complete.
X
State of ____________________County of ____________________
(Signature) __________________________________________________
Controlling Person / Agent
the foregoing instrument was acknowledged before me this
____________ of ______________________ _____________
Day
Month
Year
My commission expires on:
___________________
___________________________________________________
Signature of NOTARY PUBLIC
FOR DEPARTMENT OF LIQUOR USE ONLY
Officer Signature:
Approval
Disapproval
Date:_____________________________
2/17/2016
Individuals requiring ADA accommodations please call (602)542-9027
ADVERTISEMENT
0 votes
Related Articles
Related forms
Business Information / Name Change Request - Arizona Department Of Liquor Licenses And Control
Legal
Application For Out-of-state Producer Liquor Licenses- Arizona Department Of Liquor Licenses And Control
Legal
Application For Growler Privileges With Series 12 Liquor License - Arizona Department Of Liquor Licenses And Control
Legal
Application For Liquor License Type Or Print With Black Ink - Arizona Department Of Liquor Licenses And Control
Legal
Application For Agent Change - Acquisition Of Control - Restructure - Arizona Department Of Liquor Licenses And Control
Legal
Application For Extension Of Premises/patio Permit - Arizona Department Of Liquor Licenses And Control
Legal
Related Categories
Parent category: Legal