| City of Cape Girardeau, Missouri | ||
|
401 INDEPENDENCE Application for Liquor License |
|
| City of Cape Girardeau, Missouri | ||
|
401 INDEPENDENCE Application for Liquor License |
|
_____ 3.2%
NON-INTOXICATING BEER BY DRINK (E)
_____
5% BEER BY DRINK (F)
_____
RETAIL LIQUOR BY THE DRINK (H)
_____
ORIGINAL PACKAGE 3.2% BEER (G)
_____
ORIGINAL PACKAGE 5% BEER (G)
_____
ORIGINAL PACKAGE LIQUOR (I)
_____
WHOLESALERS OF MALT LIQUOR NOT IN EXCESS OF 5% (C)
_____
WHOLESALERS OF INTOXICATING LIQUOR – UNDER 22% (D1)
_____
WHOLESALERS OF INTOXICATING LIQUOR – ALL KINDS (D2)
_____
PERMIT TO ALLOW COMSUMPTION OF LIQUOR – RESTAURANTS (J)
(SUNDAY SALES)
_____ MANUFACTURERS
OF BEER (A)
_____ DISTILLERS
AND MANUFACTURERS OF LIQUOR (B)
_____ WINE TASTING (M)
NAME
OF APPLICANT___________________________________________________
D/B/A__________________________________________________________________
ADDRESS
OF APPLICANT________________________________________________
APPLICANT
HOME PHONE________________BUSINESS PHONE______________
TYPE
OF OWNERSHIP (check one only)
_____ Corporation
_____ Partnership
_____ Proprietorship or sole owner
STREET
ADDRESS AND SPECIFIC DESCRIPTION OF PREMISES WHICH LICENSE APPLIED FOR WOULD
COVER (i.e. NUMBER OF ROOMS, NUMBER OF STORIES, OUTDOOR SEATING AREAS, ETC.)
ALL AREAS LISTED ARE SUBJECT TO INSPECTION BY CITY INSPECTORS AND MUST
MEET CODE REQUIREMENTS.
ADDRESS:______________________________________________________________
DESCRIPTION:__________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
ARE
YOU IN PRESENT POSSESSION OF PREMISES DESCRIBED PREVIOUSLY?
YES__________NO_________
ARE
ANY ALTERATIONS TO THE BUILDING OR PREMISES CURRENTLY UNDER WAY OR PLANNED IN
THE IMMEDIATE FUTURE?
IS
THE BUILDING IN WHICH THE LICENSED PREMISES ARE LOCATED,
LOCATED
WITHIN 200 FEET OF ANY SCHOOL OR CHURCH OR RESIDENT
BUILDING?
YES__________NO_________
IF
YES, STATE
THE NAME AND ADDRESS OF THE SCHOOL OR CHURCH AND
PROVIDE
WITH APPLICATION A LETTER FROM THE GOVERNING BOARD OF
THE
SCHOOL OR CHURCH CONSENTING TO THE LIQUOR LICENSE.
ALL
QUESTIONS ON THIS APPLICATION MUST BE ANSWERED COMPLETELY BEFORE THE
APPLICATION WILL BE CONSIDERED. ANSWERS
MUST BE TYPED OR LEGIBLY PRINTED. WHERE
NECESSARY, ANSWERS SHOULD BE COMPLETED ON ADDITIONAL SHEETS OF PAPER.
1.
TO BE COMPLETED BY CORPORATIONS ONLY.
State
the exact corporate name of applicant: __________________________________________
State
the date and place of incorporation: _____________________________________________
State
the address of the principal office of the corporation: _______________________________
State
the names and residence addresses of all officers of the corporation and the
office held by each:
FULL
NAME
ADDRESS
OFFICE
D.O.B.
(AND
MAIDEN NAME
IF
APPLICABLE)
State
names of all stockholders and the number of shares owned by each (if not a
closely held corporation, list those who own at least 10% of issued stock.)
FULL
NAME (AND MAIDEN NAME IF APPLICABLE) NUMBER OF SHARES
2.
TO BE COMPLETED BY PARTNERSHIPS ONLY.
State the name of partnerships_______________________________________________
State date partnerships was formed____________________________________________
State names of all partners:
FULL NAME
D.O.B.
DRIVERS LIC. NO.
(AND MAIDEN NAME
IF APPLICABLE)
ALL
REMAINING QUESTIONS MUST BE COMPLETED BY ALL APPLICANTS:
1.
PROVIDE
THE FOLLOWING INFORMATION PERTAINING TO THE MANAGING OFFICER OF THE
CORPORATION, EACH PARTNER OF A PARTNERSHIP OF THE OWNER OF A SOLE
PROPRIETORSHIP:
Full name (and maiden name if
applicable)___________________________________________
Current residence
address_________________________________________________________
Length of residency at current
address_______________________________________________
Date of birth_________________Is the managing officer
a
Place of
birth______________________________________S.S.N.________________________
Current Driver’s License:
number_____________________state_________________________
All former driver’s license:
(list state and number)_____________________________________
All former names and times when used:
FULL NAME
FROM
TO
All former residence addresses for past fifteen years
and date of residence for each address:
ADDRESS
FROM
TO
1.
State
the type of business for which you seek a liquor license.
5. Describe
all related activities which you intend to conduct on the premise for which
you seek
a
license.______________________________________________________________________
6. Is the
owner, managing officer, corporation, any stockholder owning 10% or more of
issued stock, or any partner, or any member of family interested directly or
indirectly in any other license issued by the Supervisor of Liquor Control or
the City of
If so, give details:
_______________________________________________________________
7.
Has the
owner, managing officer, corporation, any stockholder owning 10% or more of
issued
stock, or any partner, or any member of owner’s, managing officer’s, or
any partner’s household or immediate family at any time in the past, held a
license from the Supervisor of Liquor Control or the City of
If so, give details:
_______________________________________________________________
7.
Has the
owner, managing officer, corporation, any stockholder owning 10% or more of
issued stock, or any partner, or any member of
owner’s, managing officer’s, or any partner’s household or immediate
family ever made application for a license from the Supervisor of Liquor
Control or the City of
If so, name the applicant, date of denial and details
regarding same. _____________________
8.
Has the
owner, managing officer, corporation, any stockholder owning 10% or more of
issued stock, or any partner, or any member of
owner’s, managing officer’s, or any partner’s household or immediate
family ever had any license issued by the Supervisor of Liquor Control of the
State of Missouri or by the licensing authority of any other state or by any
city, suspended or revoked? _____________If so, give
details_________________________________________
10. Is
there now employed, or do you expect to employ, in the business sought to be
licensed hereunder any person who has at any time had a license from the
Supervisor of Liquor Control revoked or suspended? ______________ If so, give
details_______________________________
11.
Has
the owner, managing officer, corporation, any stockholder owning 10% or more
of
issued stock, or any partner ever been employed by
any person, partnership, or corporation that had a license suspended or
revoked by the Supervisor of Liquor Control of the State of
_____________ If so, give details:
__________________________________________________
12. Has
any license heretofore issued by the Supervisor of Liquor Control for the
premises for which you seek a license ever been suspended or revoked by the
Supervisor of Liquor Control of the State of
13. Has
the owner, managing officer, or any partner ever been arrested or indicted for
the violation of any Federal Law, law of the State of
If so, give details:
_______________________________________________________________
14. Has
the owner, managing officer, or any partner ever been convicted of any crime
in any Missouri Court, any Court of any other State, any Federal Court or any
Court of any other Country? ______________________ If so, give details:
_________________________________
______________________________________________________________________________
15. Has
the owner, managing officer, or any partner ever been convicted of the
violation of any ordinance of any city relating to intoxicating liquor
gambling, immorality, fighting, or peace disturbance? _______________ If so,
give details: ______________________________________
16. Has
the owner, managing officer or any partner or any member of owner’s,
managing officer’s or partner’s household or immediate family ever been
convicted of any Federal Law or law of any state concerning intoxicating
liquor? _________________. If so,
give details as to each conviction, giving name of person convicted, date and
nature of offense, court where sentence was entered, and sentence imposed or
fine imposed. _____________________________
17. Is
there now employed or do you expect to employ, in the business hereunder any
person who has been convicted of any crime? _________________________If so,
give details______
18.
Do you
own or rent the premises for which you seek a license?
________________________
19.
Who is
your landlord? ________________________________________________________
20. What
interest, if any, does your landlord have, directly or indirectly, in the
business which you intend to engage in if the license is granted?
_______________________________________
21.
Does
your landlord now hold, or has he ever held, a license of any kind issued by
the
Supervisor
of Liquor Control? __________________________________________________
22.
Did you
pay the former owner the total purchase price in cash?________If not, state in
detail
manner of
payment? _____________________________________________________________
23. Does
the former owner of the business have any interest either directly or
indirectly in the business for which you seek a license? _______________If so,
give details: _________________
24. Give
the name of any person, firm, or corporation holding any mortgage or
encumbrances of any kind against the business for which you seek a license.
______________________________
26. Does
the owner, managing officer, corporation, any stockholder, or any partner have
any interest directly or indirectly in any brewery, winery, distillery,
rectifying or blending plant or wholesale liquor concern either as part owner,
stockholders, agent or employee or otherwise?
_____________If so, give
details___________________________________________________
you and except such articles and services, if any, as
are permitted by the regulations of the Supervisor of Liquor Control.
_______________________________________
29.
State the name and residence of any person, firm or corporation, if
any, who is interested, or who will become interested, directly or
indirectly, other than hereinabove set out, in the business for which you
seek a license and the nature of such interest.
______________________________
30. Has
any bonding company ever cancelled any bond signed by it for the owner,
managing officer, corporation, any stockholder owning 10% or more of issued
stock, or any partner in connection with any license issued to you by the
Supervisor of Liquor Control? ______________
31. Has
any bonding company ever refused to sign any such bond for the owner, managing
officer, corporation, any stockholder owning 10% or more of issued stock, or
any partner?
______________________________________________________________________
32. Is
this application a subterfuge to permit any person other than yourself or the
corporation to secure a license from the City of
33. Execute
the appropriate acknowledgement.
FOR
PARTNERS OR SOLE PROPRIETORS:
STATE OF
)
ss.
____________________________________________________,
of lawful age being first duly sworn upon oaths, depose and say that (he, she)
have read this application and the instructions with reference thereto and
that (he, she, they) fully understand the same; that (he, she) know the
contents and the statements contained therein and that the same are true.
Applicant has personal knowledge of the information contained the
application and has read the provisions of Article XV of Chapter 15 of the
Code of Ordinances of the City of Cape Girardeau, Missouri.
__________________________________________
__________________________________________
__________________________________________
Subscribed and sworn to me before this _______day of
___________________,_____________
_________________________________________
_________________________________________
NOTARY PUBLIC
My Commission Expires:
_____________________________
FOR
MANAGING OFFICER OF CORPORATION/PARTNERSHIP:
STATE OF
) ss.
)
__________________________________________________,
of lawful age, being first duly sworn upon (his, her) oath, deposes and says
that (he, she) is the managing officer of the corporation seeking a license
hereunder, that (he, she) has been authorized by said corporation to make this
application in its behalf, that (he, she) has read this application and the
instructions with reference thereto, and that (he, she) fully understand the
same and that (he, she) knows the contents thereof and the answers and
statements contained therein and the same are true.
_______________________________________
_______________________________________
Subscribed and sworn to before me this___________ day
of ____________________,________
______________________________________
______________________________________
NOTARY PUBLIC
My Commission Expires:
_________________________
