APPLICATION FOR A LIQUOR LICENSE CITY OF ST. JOSEPH

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Rudolph Richard
5 years ago
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1 APPLICATION FOR A LIQUOR LICENSE CITY OF ST. JOSEPH Date I hereby make application to the City of St. Joseph, Missouri, for a permit to sell alcoholic beverages at retail for the following: (check type of license sought). Retail Liquor by Drink 5% Beer & Light Wine by Drink 3.2% Beer by Drink Retail Package Liquor 5% Package Beer 3.2% Package Beer Wholesale Liquor Wholesale Beer Sunday Restaurant/Bar Amusement Sunday Amusement Sunday Original Package Sunday Not For Profit COL Other As Sole Proprietor Partnership Corporation LLC If a partnership, list name and address of each partner If a corporation or LLC, list corporate name TRADE NAME OF BUSINESS ADDRESS ZIP CODE BUSINESS PHONE 1. Applicant or Managing Officer Name 2. Address Date of Birth Place of Birth 3. How long immediately preceding the date of this application has he/she lived there? 4. Give address where he/she has resided for the last 10 years. 5. Is Applicant/Managing Officer an U.S. Citizen? If naturalized, give date and place of naturalization. 6. In what city, town or village does he/she pay taxes? 7. Is he/she a legal voter in the State of Missouri? If so, in what precinct, ward, city and county does he/she vote? 8. Has he/she ever been arrested anywhere in the United States for violation of any city, state or federal law? (Do not include minor traffic infractions) If so, give complete details. 9. Has he/she ever pleaded or been found guilty in any court anywhere in the United States for any offense for which you served jail time, received a suspended sentence, were placed on probation or paid a fine? (Do not include minor traffic infractions with under a $50.00 fine) If so, give complete details. 10. Has he/she ever pleaded guilty or been convicted of a felony? If so, give complete details:

2 11. Has he/she ever been the holder of any permit/license to manufacture or sell alcoholic beverages which was revoked? If so, give complete details. 12. Is he/she, or any member of household or immediate family, interested directly or indirectly in any other license to sell alcoholic beverages in any state? If so, give complete details. 13. Has he/she or any member of his/her household or immediate family ever applied for a permit/license to manufacture or sell alcoholic beverages in any jurisdiction, which was denied? If so, give the name of applicant, approximate date of denial and complete details. 14. Is there now employed, or will you employ, any person in the business to be licensed who has at any time had a license from the Supervisor of Liquor Control of the City of St. Joseph revoked or suspended? 15. Is there now employed, or do you expect to employ, any person in the business to be licensed who has ever been arrested or indicted for the violation of any federal law or state law? If so, give complete details. 16. Has anyone in your employ ever been convicted of any crime in any Missouri court, or any court of another state or county, or any federal court? If so, give complete details. 17. Has anyone in your employ ever been convicted of the violation of any ordinance of any state or city, including St. Joseph, relating to intoxicating liquor, gambling, immorality, fighting or peace disturbance, If so, give complete details. 18. Has anyone in your employment or whom you expect to employ, or any member of their household or immediate family, ever been convicted of a violation of any city, state or federal law, concerning intoxicating liquor? If so, give complete details as to each conviction, and the name of the person convicted, date, nature of offense, court where sentence was entered, and sentence or fine imposed. 19. Has there been issued to anyone in your business, within the past year, a Retail Liquor Dealers Federal Tax Stamp designating the premises for which you seek a license as a person or place for dealing intoxicating liquors other than malt liquors. Yes No 20. Specify if you own, rent or lease the premises for which you seek a license. (Enter landlord s name and address and the amount of rent paid). 21. Does the former owner of the business, either directly or indirectly, have any interest in the business for which you seek a license? If so, give complete details. 22. If you are purchasing the business, give name of person from whom you are purchasing it and the amount you are to pay for it. 23. Did you agree to pay the owner the total purchase price in cash? Yes No If not, state in detail the manner of payment. 24. State the name of any person or corporation holding any mortgage or encumbrance of any kind against the business for which you seek a license. If so, state the amount of mortgage or encumbrance and terms of payment. 25. State the name of any person, firm or corporation that has advanced, or that will advance, any money to you to purchase or operate the business for which you seek a license. 26. Does any person, stockholder, or managing officer have any interest, directly or indirectly, in any brewery, winery, distillery, rectifying or blending plant or wholesale liquor concern, either as part owner, stockholder, agent, employee, or otherwise? If so, give complete details. 27. State the name and address of any distiller, wholesaler, winemaker, brewer, or any employee, officer or agent thereof, who has or will have any financial interest, directly or indirectly, in the business for which you seek a license.

3 28. State the name of any distiller, wholesaler, winemaker, brewer, or any employee, or agent thereof, who has or will, directly or indirectly, loan, give away, or furnish equipment, money, credit or property of any kind to you, except ordinary commercial credit for liquors sold to you and except such articles and services as are permitted by the regulations of the Supervisor of Liquor Control. 29. State the name and residence of each person, firm, or corporation interested or to 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. What is the distance in feet, measured in a straight line, from the nearest point of the above described premises to the nearest point of the premises of the nearest school, church, or other building regularly used as a place of religious worship? 31. If this application is for a Retail Package Dealer License, state the character of the business applicant is engaged in and what types, amounts and values of merchandise does the applicant have on hand? IF BUSINESS IS A CORPORATION, COMPLETE THIS SECTION 32. Name of Corporation State of Incorporation Date of Incorporation 33. Name of Managing Officer for Corporation 34. Name and address of all stockholders and number of shares owned by each. 35. Names, titles and addresses of corporate officers 36. Is the Corporation or any stockholder or the managing officer thereof, or any member of his household or immediate family directly or indirectly interested in any other permit/license to sell alcoholic beverages in any State? If so, give complete details. 37. Has the Corporation or any stockholder or the managing officer thereof, or any member of his family, at any time in the past held a permit/license issued by any jurisdiction? If so, give name of such permittee, trade name and location of premises. 38. Has any stockholder of the Corporation or the managing officer ever been employed by any person, partnership, or corporation that had a permit/license revoked or suspended by the Supervisor of Liquor Control? If so, give complete details. 39. State the name and residence of each person, firm or corporation, if any, other than applicant corporation and its stockholders, interested, directly or indirectly, in the business for which a permit/license is sought and the nature of such interest. 40. Is this application being made by the Corporation as a subterfuge to permit any person than yourself to obtain a permit from the City of St. Joseph, in your name, for his/her benefit?

4 AFFIDAVIT State of County of, being first duly sworn, upon his/her oath states: That he/she is the president of, a corporation in good standing, authorized to do business in the State of Missouri, with its principal place of business in and duly organized and existing pursuant to the laws of the State of, and in whose behalf he/she makes this Affidavit. That, Name of Managing Officer Residence Address, has been designated and appointed Managing Officer City/ State of seeking the subject liquor license herein, Name of Corporation Pursuant to authority of its Board of Directors for operation in St. Joseph, Missouri, with a business address of, said Managing officer is in the Corporation s employ with general superintending control of the corporation s business at said location. President on behalf of ATTEST Corporate Secretary (Seal) Corporation Name Personally appeared before me the above-named, known or proved to be the same person who executed the foregoing instrument and to be the President of, and acknowledged to me that he/she executed the same as his/her free act and deed and the free act and deed of said corporation. Subscribed and sworn to before me this day of, Notary Public in and for the (seal) County of State of My Commission expires:

5 STATE OF MISSOURI COUNTY OF BUCHANAN CITY OF ST. JOSEPH I, (please print) Applicant or Managing Officer Being of lawful age and duly sworn upon my oath do swear that the answers and information given in this application are true and complete to the best of my knowledge and belief. Signature of Applicant or Managing Officer Subscribed and sworn before me this day of, 2000 Notary

ST. LOUIS COUNTY DIVISION OF LICENSES APPLICATION FOR LIQUOR LICENSE-CORPORATION

ST. LOUIS COUNTY DIVISION OF LICENSES APPLICATION FOR LIQUOR LICENSE-CORPORATION All applicants are encouraged to contact the Code Enforcement Department and Zoning Department to discuss the nature of