Application For Liquor License Menard County Illinois printable pdf download

APPLICATION FOR LIQUOR LICENSE

Menard County, Illinois

Name of Applicant:___________________________________________________________________________

Name of person completing this form if different from above:_________________________________________

Address of Applicant:_________________________________________________________________________

Contact telephone number:_______________________________________________________________

Location & legal description of premises for which license is sought:___________________________________

___________________________________________________________________________________________

Applicant’s date of birth:_______________________________________________________________________

Driver’s License #:_______________________________________________________

Position with business:________________________________________________________________________

Percentage of ownership in the business:__________________________________________________________

Name(s), date of birth, driver’s license #, position and percentage of ownership in the business of every partner,

corporate officer, director, manager and any person who owns 5% or more of the shares of the business or parent

corporation of the business:

Driver’s

Name &

Date of

Position in

% Ownership

Address

Birth

License #

Business

___________________________________________________________________________________________

If a “club” within the meaning of the Ill. Rev. Stat., Ch. 43, Par. 95.24, attach hereto, two (2) copies of a

list of names and residences of your members.

If a club, are your affairs and management conducted by a board of directors, executive committee or

similarly body chosen by the members at their annual meeting?_________________________________

Is any member, officer, agent or employee of the club paid any profit from the distribution or sale of

Application For Liquor License Menard County Illinois