APPLICATION FOR LICENSE FOR RETAIL SALE OF LIQUOR UNDER THE VILLAGE OF RIVERSIDE ALCOHOLIC LIQUOR CONTROL ORDINANCE

Transcription

1 APPLICATION FOR LICENSE FOR RETAIL SALE OF LIQUOR UNDER THE VILLAGE OF RIVERSIDE ALCOHOLIC LIQUOR CONTROL ORDINANCE NEW RENEWAL The undersigned hereby makes application for the issuance of a license to engage in the business of selling alcoholic liquors, as indicated hereafter, for the period commencing, (date) and ending April 30, 20. (Please check the Class for which application is made. Class License Fees payable in advance on or before May 1 of each year.) A non-refundable application fee of $300 is due with this application. CLASS A $1, License to sell and offer for sale at retail in the premises specified, beer and wine in the original container only, and not for consumption on the premises where sold. (Between the hours of 9:00 a.m. to 11:00 p.m. on weekdays and Saturday and 9:00 a.m. to 11:00 p.m. on Sunday). CLASS A-1 $3, License to sell alcoholic liquor in sealed packages but not for consumption on the premises where sold. Holders of the Class A-1 licenses shall be permitted to conduct alcoholic liquor sampling or tasting promotions upon the licensed premises; provided, that no charge shall be made. (Between the hours of 9:00 a.m. to 11:00 p.m. on weekdays and Saturday and 10:00 a.m. to 11:00 p.m. on Sunday). CLASS B Special $10, License to sell and offer for sale at retail in the premises specified, beer and wine for consumption on the premises at the facilities of the Chicago Zoological Society. (Between the hours of 11:00 a.m. to 6:00 p.m. on weekdays and Saturday and 12:00 noon to 6:00 p.m. on Sunday). CLASS BYOB - Bring-your-own-bottle ( BYOB ) license, which shall authorize businesses to allow their patrons to bring beer and wine in closed containers into the premises for their personal consumption while food is being served in said establishment. Beer and wine consumption shall be limited to those hours when food service is available. With seating capacity of 50 or less ($165.00), with seating capacity of 51 to 100 ($330.00), with seating capacity of 101 or more ($475.00). Between the hours of 11:00 a.m. and 11:00 p.m. on weekdays and 12:00 midnight on Saturday and 12:00 noon to 11:00 p.m. on Sunday). CLASS C (Restaurants) License to sell and serve beer and wine for consumption on the premises where sold when provided as part of food service. With seating capacity of 50 or less ($770.00), with seating capacity of 51 to 100 ($1,320.00), with seating capacity of 101 to 150 ($1,900.00). (Between the hours of 11:00 a.m. to 11:00 p.m. on weekdays and 12:00 midnight on Saturday and 12:00 noon to 11:00 p.m. on Sunday). CLASS D (Bowling Alleys) $1, to sell alcoholic liquor. (Between the hours of 11:00 a.m. to 11:00 p.m. on Monday through Thursday, and 11:00 a.m. to 12:00 midnight on 1

2 Friday and Saturday, and 12:00 noon to 11:00 p.m. on Sunday). CLASS E (Restaurants) License to sell and service mixed drinks for consumption on the premises. With seating capacity of 50 or less ($1,050.00), with seating capacity of 51 to 100 ($1,800.00), with seating capacity of 101 to 150 ($2,700.00). (Between the hours of 12:00 noon to 12:00 midnight on Monday through Thursday; between 12:00 noon to 1:00 a.m. on Friday; between 10:00 a.m. and 1:00 a.m. on Saturday; and between 10:00 a.m. and 10:00 p.m. on Sunday). On January 1, the closing hours shall be 2:00 a.m. CLASS P Brew Pub License, which shall authorize the on-site manufacture and storage of beer at a designated premises and the making of sales to importing distributors and distributors, as well as the direct retail sale to nonlicensee consumers for consumption off the designated premises in sealed containers or on the designated premises through a full service restaurant. The number of gallons of beer sold by a brewpub each year for off premises consumption shall not exceed the number of gallons authorized for sale each year by a brewpub in the liquor control act of Class P licensees must have at least one BASSET certified site manager on premises whenever offering alcohol for sale. Every class P licensee must have a valid brewpub license from the state of Illinois. A brewpub may also offer for sale at retail, for use and consumption on the licensed premises, any beer or wine purchased from a licensed distributor or importing distributor. With seating capacity of 50 or less ($385.00), with seating capacity of 51 to 100 ($660.00), with seating capacity of 101 or more ($950.00). Between the hours of 11:00 a.m. and 11:00 p.m. on weekdays and 12:00 midnight on Saturday and 12:00 noon to 11:00 p.m. on Sunday). CLASS Q Microbrewery microbrewery license, which shall authorize the on-site manufacture and storage of craft beer at a designated premises and the making of sales to importing distributors and distributors, as well as the direct retail sale to non-licensee consumers for consumption off-site in sealed containers or on the designated premises in an accessory tap room. The number of gallons of beer sold by a microbrewery each year for off-premises consumption shall not exceed the number of gallons authorized for sale each year by a brewpub as defined in the liquor control act of Class Q licensees must have at least one BASSET certified site manager on premises whenever offering alcohol for sale. Every class Q licensee must have a valid brewpub license from the state of Illinois. With seating capacity of 50 or less ($385.00), with seating capacity of 51 to 100 ($660.00), with seating capacity of 101 or more ($950.00). Between the hours of 11:00 a.m. and 11:00 p.m. on weekdays and 12:00 midnight on Saturday and 12:00 noon to 11:00 p.m. on Sunday). CLASS W-1 (Wine Bar) Wine by the glass for consumption with and without food on the premises or sale of wine by the bottle for consumption on or off the premises. Wine sales shall be limited to those hours when food service is available. Only employees of the licensed establishment shall provide service of such alcoholic liquors. With seating capacity of 50 or less ($385.00), with seating capacity of 51 to 100 ($660.00), with seating capacity of 101 or more ($950.00). Between the hours of 11:00 a.m. and 11:00 p.m. on weekdays and 12:00 midnight on Saturday and 12:00 noon to 11:00 p.m. on Sunday). CLASS X Craft Distillery $385 License shall authorize the on-site production and 2

3 storage of alcoholic liquor beverages, including specifically spirits and wine, in quantities not to exceed the number of gallons authorized for production each year by a craft distillery and limited wine manufacturer in the liquor control act of , for sale by the bottle for off premises consumption or by the glass for consumption in an accessory tasting room or retail outlet. A tasting room or retail outlet allows patrons to taste samples of products manufactured on site, and to purchase products by the glass or bottle for either on site or off premises consumption, and to purchase related sales items. Sales of alcohol manufactured outside the site are prohibited. Class X licensees must have at least one BASSET certified site manager on premises whenever offering tasting samples of alcohol. Every class X licensee must have a valid craft distiller license, and, if applicable, a limited wine manufacturer s license, from the state of Illinois. Sales of food and non-alcoholic beverages are permitted, but the sale or consumption of alcoholic liquor manufactured outside of the facility is prohibited. (Between the hours of 11:00 a.m. to 11:00 p.m. on Monday through Thursday, and 11:00 a.m. to 12:00 midnight on Friday and Saturday, and 12:00 noon to 11:00 p.m. on Sunday). 3

4 LIQUOR APPLICATION CHECKLIST Fingerprints Taken: Individual Applicant Liquor Manager Individuals owning more than 5% of interest Bartenders Application Fee: $ Liquor Manager s Application (if applicable) Copy of Lease (if applicable) Corporation Papers: (if applicable) Articles of Incorporation Certificate of Good Standing Foreign Corporation Documents Proof of Liquor Liability Insurance Coverage Floor Plan, Diagram or Drawing of the Business Premises Proof of completion of BASSET program Surety Bond: $1, A STATE OF ILLINOIS LIQUOR LICENSE IS REQUIRED. CONTACT THE AGENCIES BELOW FOR FURTHER INFORMATION AND NECESSARY REQUIREMENTS. Chicago Address: Springfield Address: 100 W. Randolph Street Suite West Jefferson Chicago, Illinois Springfield, Illinois Phone: Phone: **** Please refer to Chapter 2, Title 3 of the Riverside Village Code Regarding Liquor Licenses for more information concerning Village Ordinances**** 4

5 Corporate Applicant Information: APPLICATION FOR LIQUOR LICENSE CORPORATION 1. Applicant's Corporate Name 2. Name Under Which Business is to be Conducted 3. Date of Incorporation A. Under law of the State of B. If a foreign corporation, the date when authorized to do business in Illinois as a foreign corporation and that it is still licensed as a foreign corporation to do business in Illinois Yes No NOTE: Attached certificate of the Illinois Secretary of State C. Objectives or purposes of the corporation NOTE: Copy of articles of incorporation must be submitted with application 4. State names of all owners, directors and officers as indicated, with the required information. (NOTE: If more than two directors, attach separate sheet with required information for additional directors.) A. President Residence address Phone Number Date of Birth Social Security No. Place of Birth Percentage of stock or interest owned 5

6 B. Vice President Residence address Phone Number Date of Birth Social Security No. Place of Birth Percentage of stock or interest owned C. Secretary Residence Address Phone Number Social Security No. Date of Birth Place of Birth Percentage of stock or interest owned D. Treasurer Residence Address Phone Number Social Security No. Date of Birth Place of Birth Percentage of stock or interest owned E. Director Residence Address Phone number Social Security No. Date of Birth Place of Birth Percentage of stock or interest owned 6

7 5. List below persons or corporations owning five percent (5%) or more of the stock of the applicant or having an ownership interest in the business of the applicant other than those named to Question 4, with the required information. (Note: Attached additional sheets if necessary for complete listing.) A. Name Residence Address Phone Number Social Security No. Date of Birth Place of Birth Percentage of stock or interest owned B. Name Residence Address Phone Number Social Security No. Date of Birth Place of Birth Percentage of stock or interest owned C. Name Residence Address Phone Number Social Security No. Date of Birth Place of Birth Percentage of stock or interest owned Should the answer to Question 5 disclose that a corporation owns five percent (5%) or more of the stock of the applicant corporation, attach a separate sheet answering Question 3 for that corporation. 7

8 6. Has any officer or director of applicant corporation, or any stockholder(s) owning in the aggregate more than five percent (5% of the stock of such corporation, ever been convicted of any felony (include expungements) under any federal or state law? Yes No If so, give dates and state the offense and circumstances thereof 7. Has any officer or director of applicant corporation, or any stockholder(s) owning in the aggregate more than five percent (5% of the stock of such corporation), ever been convicted of being the keeper of a house of ill fame or of pandering or of other crime or misdemeanor opposed to decency and morality or of any federal, state or local gambling offense? Yes No If so, gave dates and state the offense and the circumstances thereof 8. Has any officer or director of applicant corporation, or any stockholder(s) owning in the aggregate more than five percent (5% of the stock of such corporation), ever been convicted of a violation of any federal, state or local liquor law? Yes No If so, give dates and state the offense 9. Has any officer or director of applicant corporation, or any stockholder(s) owning in the aggregate more than five percent (5% of the stock of such corporation)ever permitted an appearance bond forfeiture for any of the violations mentioned in Questions 6, 7 or 8? Yes No 10. Has any officer or director of applicant corporation, or any stockholder(s) owning in the aggregate more than five percent (5% of the stock of such corporation), ever made a similar application for a similar license on premises other than described in this application? Yes No If yes, give address and disposition of such application 8

9 11. Has any officer or director of applicant corporation, or any stockholder(s) owning in the aggregate more than five percent (5% of the stock of such corporation), ever have any license issued by any federal, state or local authorities revoked? Yes No If yes, give the date and reasons 12. Has any officer or director of applicant corporation, or any stockholder(s) owning in the aggregate more than five percent (5% of the stock of such corporation), ever been issued a Federal Gaming Device Stamp or Federal Wagering Stamp? Yes No Business Information 1. The entity s Illinois state liquor license number. (Please attach proof of state licensure to this application.) 2. Name of establishment for which license is sought 3. Location of place of business for which license is sought 4. Phone number of place of business 5. Hours of operation. Full legal description of the premises for which license is sought 6. Full description of establishment, specifying number of floors, rooms, square feet, number of tables in dining area, number of seats at bar, etc. 7. Does applicant corporation own premises for which license is sought? Yes No If not, when does applicant s lease expire? NOTE: Signed copy of least for the full term of the License being sought shall be included with this application 8. Has any manufacturer, wholesaler, distributor or importing distributor of alcoholic liquor or any person connected with or in any was representing, or has any member of the family of such manufacturer, wholesaler, distributor, or importing distributor, or any stockholder 9

10 in any corporation engaged in manufacturing, wholesaling or distributing or such liquor, or any officer, manager, agent or representative of said manufacturer, wholesaler, distributor or importing distributor directly or indirectly paid or agreed to pay for this license, advance money or anything else of value, or any credit (other than merchandising credit in the ordinary course of business for a period not to exceed thirty (30) days, or is such person or corporation directly or indirectly interested in the ownership, conduct or operation of this place of business? Yes No If yes, give particulars, including name(s) and address(es) 9. Is the proposed location within 100 of any church, school, hospital? Yes No 10. Is any law enforcement official, mayor, councilman, member of a city commission or board, any president or member of a county board, or any other elected official directly or indirectly interested in the business for which said license is sought? Yes No If yes, provide the nature of the relationship: 11. Does a valid policy for Liquor Liability Insurance (not less than $1 million) exist for the premises and time period for which this license is sought? Yes No NOTE: A copy of such policy must be included with this application. 12. Is or will the business be conducted by a manager or agent? Yes No If yes, the following questions must be answered by such manager or agent. A. Name B. Residence Address C. Residence Phone No. Date of Birth D. Social Security No. License No. Driver s License Number E. Place of Birth F. Are you a citizen of the United States? Yes No 10

11 If a naturalized citizen, state the time and place of naturalization (Month/Day/Year) City/State Court (or law) under which naturalized *Fingerprints of each manager and currently employed bartender must be supplied to the Riverside Police Department. G. Have you ever been convicted of any felony under any federal or state law? Yes No If so, give dates and state the offense and circumstances thereof H. Have you ever been convicted of being the keeper of a house of ill fame or of pandering or of other crime or misdemeanor opposed to decency and morality or of any federal, state or local gambling offense? Yes No If so, gave dates and state the offense and the circumstances thereof I. Have you ever been convicted of a violation of any federal, state or local liquor law? Yes No If so, give dates and state the offense J. Have you ever permitted an appearance bond forfeiture for any of the violations mentioned n Questions G, H or I? Yes No 11

12 Signature of manager or agent 13. State authority conferred upon manager or agent, if any, with respect to operation or management of the business for which this license is sought 14. What is your retailer s occupation tax (ROT) registration number. Are you delinquent in the payment of the retailer s occupation tax (sales tax) and, if so, the reasons therefore. Yes No If so, give reasons 15. The applicant shall submit financial information demonstrating the financial capability to open and operate the establishment. The Village Manager or his/her designee shall determine what financial information is needed, and notify the applicant accordingly. All financial information shall be deemed confidential by the Village. The financial information submitted shall be available for consideration by the Local Liquor Control Commissioner in the review of the application for the initial license or for the renewal of a license. 16. Submit a floor plan, diagram, or drawing deemed suitable by the Local Commissioner, illustrating the premises, in which alcoholic liquor is to be sold. Obtain and submit current zoning of the premises at which the place of business is to be operated. (Please attach to application.) 17. Submit a proof of completion of a beverage alcohol sellers and servers education training ( BASSET ) program as required by the Village by all facility managers and any number of other current employees. (Please attach to application.) 18. Submit a surety bond in the amount of one thousand dollars ($1,000.00) acceptable to the Village. Such bond shall provide against any violation by the principal, his agents, or employees, of any of the Riverside Village Code, as amended, or any ordinances, rules and regulations now in force or which may hereafter be in force in said Village affecting the operation of business. (Please attach to application.) 19. Applicant hereby acknowledges receipt of a copy of the ordinance of the Village of Riverside relating to the licensing, sale, distribution and consumption of liquor. Signature of President Dated at Riverside, Illinois,, 20 12

13 APPLICATION FOR LIQUOR LICENSE INDIVIDUALS AND NON-INCORPORATED ENTITIES (INCLUDING PARTNERSHIPS) Applicant Information: 1. Applicant's Full Name (If a partnership, list names of all general and limited partnerships owning more than 5% of the aggregate limited partner interest in such co-partnership) 2. Applicant s Residence Address: A. Telephone Number: B. Date of birth: 3. If a limited liability company: A. Date of registration as an LLC: B. Business purpose for which the LLC was formed: C. Telephone number: 4. List below the names of each individual owner, partner, joint venturer, manager of an LLC, or member of an LLC, owning five percent (5%) or more of the interest in the business of the applicant with the required information. (Note: Attached additional sheets if necessary for complete listing.) A. Name Residence Address Phone Number Social Security No. Date of Birth Place of Birth Percentage of interest owned B. Name Residence Address Phone Number Social Security No. 13

14 Date of Birth Place of Birth Percentage of interest owned C. Name Residence Address Phone Number Social Security No. Date of Birth Place of Birth Percentage of interest owned 5. Has any individual owner, partner, joint venturer, manager of an LLC, or member of an LLC owning more than five percent (5%) of the interest, ever been convicted of any felony (include expungements) under any federal or state law? Yes No If so, give dates and state the offense and circumstances thereof: 6. Has any individual owner, partner, joint venturer, manager of an LLC, or member of an LLC owning more than five percent (5%) of the interest, ever been convicted of being the keeper of a house of ill fame or of pandering or of other crime or misdemeanor opposed to decency and morality or of any federal, state or local gambling offense? Yes No If so, gave dates and state the offense and the circumstances thereof 7. Has any individual owner, partner, joint venturer, manager of an LLC, or member of an LLC owning more than five percent (5%) of the interest, ever been convicted of a violation of any federal, state or local liquor law? Yes No 14

15 If so, give dates and state the offense 8. Has any individual owner, partner, joint venturer, manager of an LLC, or member of an LLC owning more than five percent (5%) of the interest ever permitted an appearance bond forfeiture for any of the violations mentioned in Questions 6, 7 or 8? Yes No 9. Has any individual owner, partner, joint venturer, manager of an LLC, or member of an LLC owning more than five percent (5%) of the interest, ever made a similar application for a similar license on premises other than described in this application? Yes No If yes, give address and disposition of such application 10. Has any individual owner, partner, joint venturer, manager of an LLC, or member of an LLC owning more than five percent (5%) of the interest, ever have any license issued by any federal, state or local authorities revoked? Yes No If yes, give the date and reasons 11. Has any individual owner, partner, joint venturer, manager of an LLC, or member of an LLC owning more than five percent (5%) of the interest, ever been issued a Federal Gaming Device Stamp or Federal Wagering Stamp? Yes No Business Information 1. The entity s Illinois state liquor license number. (Please attach proof of state licensure to this application.) 2. Name of establishment for which license is sought 3. Location of place of business for which license is sought 4. Phone number of place of business 15

16 5. Hours of operation. Full legal description of the premises for which license is sought: 6. Full description of establishment, specifying number of floors, rooms, square feet, number of tables in dining area, number of seats at bar, etc. 7. Does applicant own premises for which license is sought? Yes No If not, when does applicant s lease expire? NOTE: Signed copy of least for the full term of the License being sought shall be included with this application 8. Has any manufacturer, wholesaler, distributor or importing distributor of alcoholic liquor or any person connected with or in any was representing, or has any member of the family of such manufacturer, wholesaler, distributor, or importing distributor, or any stockholder in any corporation engaged in manufacturing, wholesaling or distributing or such liquor, or any officer, manager, agent or representative of said manufacturer, wholesaler, distributor or importing distributor directly or indirectly paid or agreed to pay for this license, advance money or anything else of value, or any credit (other than merchandising credit in the ordinary course of business for a period not to exceed thirty (30) days, or is such person or corporation directly or indirectly interested in the ownership, conduct or operation of this place of business? Yes No If yes, give particulars, including name(s) and address(es) 9. Is the proposed location within 100 of any church, school, hospital? Yes No 10. Is any law enforcement official, mayor, councilman, member of a city commission or board, any president or member of a county board, or any other elected official directly or indirectly interested in the business for which said license is sought? Yes No If yes, provide the nature of the relationship: 16

17 11. Does a valid policy for Liquor Liability Insurance (not less than $1 million) exist for the premises and time period for which this license is sought? Yes No NOTE: A copy of such policy must be included with this application. 12. Is or will the business be conducted by a manager or agent? Yes No If yes, the following questions must be answered by such manager or agent. A. Name B. Residence Address C. Residence Phone No. Date of Birth D. Social Security No. License No. Driver s License Number E. Place of Birth F. Are you a citizen of the United States? Yes No If a naturalized citizen, state the time and place of naturalization (Month/Day/Year) City/State Court (or law) under which naturalized *Fingerprints of each manager and currently employed bartender must be supplied to the Riverside Police Department. G. Have you ever been convicted of any felony under any federal or state law? Yes No If so, give dates and state the offense and circumstances thereof 17

18 H. Have you ever been convicted of being the keeper of a house of ill fame or of pandering or of other crime or misdemeanor opposed to decency and morality or of any federal, state or local gambling offense? Yes No If so, gave dates and state the offense and the circumstances thereof I. Have you ever been convicted of a violation of any federal, state or local liquor law? Yes No If so, give dates and state the offense J. Have you ever permitted an appearance bond forfeiture for any of the violations mentioned in Questions G, H or I? Yes No Signature of manager or agent 13. State authority conferred upon manager or agent, if any, with respect to operation or management of the business for which this license is sought 14. What is your retailer s occupation tax (ROT) registration number Are you delinquent in the payment of the retailer s occupation tax (sales tax) and, if so, the reasons therefore. Yes No If so, give reasons 15. The applicant shall submit financial information demonstrating the financial capability to open and operate the establishment. The Village Manager or his/her designee shall determine what financial information is needed, and notify the applicant accordingly. All financial information shall be deemed confidential by the Village. The financial information submitted shall be available for consideration by the Local Liquor Control 18

19 Commissioner in the review of the application for the initial license or for the renewal of a license. 16. Submit a floor plan, diagram, or drawing deemed suitable by the Local Commissioner, illustrating the premises, in which alcoholic liquor is to be sold. Obtain and submit current zoning of the premises at which the place of business is to be operated. (Please attach to application.) 17. Submit a proof of completion of a beverage alcohol sellers and servers education training ( BASSET ) program as required by the Village by all facility managers and any number of other current employees. (Please attach to application.) 18. Submit a surety bond in the amount of one thousand dollars ($1,000.00) acceptable to the Village. Such bond shall provide against any violation by the principal, his agents, or employees, of any of the Riverside Village Code, as amended, or any ordinances, rules and regulations now in force or which may hereafter be in force in said Village affecting the operation of business. (Please attach to application.) 19. Applicant hereby acknowledges receipt of a copy of the ordinance of the Village of Riverside relating to the licensing, sale, distribution and consumption of liquor. Signature of President Dated at Riverside, Illinois,, 20 19

20 AFFIDAVIT CORPORATION STATE OF ILLINOIS ) COUNTY OF COOK ) SS VILLAGE OF RIVERSIDE ) The undersigned swears (or affirms) that the corporation in whose name this application is made will not violate any of the ordinances of the Village of Riverside or the laws of the State of Illinois or of the United States of America in the conduct of the place of business described herein, and to discipline, suspend or discharge any such person violating any provision of this ordinance and to cooperate in the enforcement of said ordinances by the authorities of the Village of Riverside, and that the statements made by me herein are true and correct to the best of my knowledge. Name of Corporation By Title Corporate Seal Affix Corporate Seal 20

21 AFFIDAVIT CORPORATE MANAGER STATE OF ILLINOIS ) COUNTY OF COOK ) SS VILLAGE OF RIVERSIDE ) I swear (or affirm) that I will not violate any of the ordinances of the Village of Riverside or the laws of the State of Illinois or of the United States of America in the conduct of the place of business described herein, that I have been given the authority to regulate the conduct of all persons engaged in such business and to discipline, suspend or discharge any such person violating any provision of this ordinance and to cooperate in the enforcement of said ordinances by the authorities of the Village of Riverside, and that the statements made by me herein are true and correct to the best of my knowledge. Name of Business Signature of Manager or Agent Subscribed and sworn to before me this day of, 20 Notary Public 21

22 AFFIDAVIT FOR INDIVIDUALS State of Illinois ) ) SS County of Cook ) I (or we) do hereby request to renew/apply for (circle the applicable option) the liquor license, Class, for the premises located at for one year beginning. (date of expiration of previous license) I (or we) swear (or affirm) that I (or we) will not violate any of the ordinances of the Village of Riverside or the laws of the State of Illinois or the laws of the United States of America, in the conduce of the place of business described herein; that I (or we) have read and understand Ordinance No. [insert new ordinance number] relating to the sale of Alcoholic Liquor, of the Code of the Village of Riverside, and any amendments thereto, and that the statements contained in the application dated are true and correct. Signature of Applicant Subscribed and Sworn to before me this day of, 20. Notary Public RENEWAL APPLICATION APPROVED: Signature of Applicant day of, 20. Liquor Control Commissioner _1.DOC 22