Application For Liquor License Menard County Illinois Page 4

the ownership, maintenance or operation of the business for bodily injury, loss of support, or death in an amount

not less than $250,000 per person and $500,000 per incident. Attach a copy of proof of financial responsbility to

the back of this application. This application will be denied if proof of financial responsibility is not attached to

the application.

If not, license cannot be issued.

The applicant hereby states that he/she will not violate any law of the State or the United States nor any

ordinance of the County in the conduct of his/her place of business and further states that the answers given to

the above questions are true and correct.

____________________________________________________

(Applicant)

State of Illinois

County of Menard

Subscribed and sworn to before me this _______________ day of ________________, ___________.

____________________________________________________

(Notary Public)

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Parent category: Financial