R99-138RESOLUTION NO. R99-/.g8
A RESOLUTION OF THE CITY COMMISSION OF THE
CITY OF BOYNTON BEACH, FLORIDA,
AUTHORIZING AND DIRECTING THE INTERIM CITY
MANAGER TO APPLY FOR AND EXECUTE ALL
NECESSARY DOCUMENTATION FOR THE
ACQUISITION OF A 2 COP W/GC LICENSE TO ALLOW
FOR THE SALE OF BEER AND WINE AT THE LINKS
OF BOYNTON BEACH RESTAURANT; AND
PROVIDING AN EFFECTIVE DATE.
WHEREAS, the restaurant services at the Links at Boynton Beach are now
under the management and control of the City of Boynton Beach, and in order to
maintain the current level of service to the public staff recommends that the City
apply for and obtain a 2COP w/GC license to allow for the sale of beer and wine at
[he restaurant;
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF
THE CITY OF BOYNTON BEACH, FLORIDA, THAT:
Section 1. The City Commission of the City of Boynton Beach, Florida
does hereby authorize and direct the Interim City Manager to apply for and execute
all necessary documentation for the acquisition of a 2COP s/GC license to allow for
lhe sale of beer and wine at The Links of Boynton Beach restaurant.
Section 2. This Resolution shall become effective immediately upon
3assage.
PASSED AND ADOPTED this /.~ day of October, 1999.
Ma~or
Vic,e/M a~yo~r~//
Mayor Pro Tem
Commissioner
Clerk
APS
APS
COP
COP
PS
COP
TYPES OF ALCOHOLIC BEVERAGE LICENSES
Beer - package sales only
Beer and Wine - package sales only
Beer - for consumption on premises and
package sales (unless package sales
are prohi, bJ.l:ed by local Zoning Dept.)
Beer and wine for conssmpl::i.on on premJ, ses
and package sales (unless package sales
are p].:o]Q, bited by local Zoni. ng Dept.)
Beer, wine, and liquor package sales only*
Beer, wine, and lJ. quor - for consumption on
premises and package sales*
*'- Quota licenses
4 COP-S Beer, wine, and liquor for consumption on
premises and package sales. Premises ipust
be a bona-fide hotel, motel, or motor court
of not ].ess than 100 transient guest rooms
(FSS 56_]..20).
4 COP-SRX Beer, wine, and ].iq,or for consumptJ.~n only.
Prealises ,lust be a bona-fide restaurant,
with a minimum of 2500 square feet under a
permanent roof, accommodations for serving.
full course meals to ].50 or more patrons at
tables, and 51% or more ~f the 'gross sales
must be derived from the sale of food and
non-alcoholic beverages (records documenting
this must be maintained at the premises).
(FSS 561.20)
4 COP-SBX Beer, .wine and ]..i. qnor for consmnption on
premi, ses. Must maintaln 12 bowling lanes.
11 C Beer, wine and .liquor for consumption on
premises only. This is a special license
:issued to specifJ, c types of clubs as de-
fined in FSS 56]..20 and 562.02.
11 C Must maintain a bona-fide cour~istinG
(G~f) ~ of at least 9 ho~clubhouse,
~ ~~ a~en~t golf facilities
and comprising in all at ].east 35 acres.
11 C Must malntain bona-fide club with not ].ess
(Tennis) than 10 regulahlon size tennJ, s courts or
4-wa].]. racquetball courts or a combi]~ation
I:ota].llng 10 courts, wlth a clubhouse:,
locker rooms, and pro shop.
JDBW Distributors ].ice,se for beer asd wine.
Surety bond of $25,000 is required.
KLD Distribntors license for beer, wi. ne and
liquor. ~;~lrelly ])on(] :i.$ $].00, 000.
IMIPR Impoi:he]Fs ] i.c:en~Je I:.ol; a].]. a].coho]..i.c
beve]yagr~. 'l'hi.s license does .oh permi, t
possession of hhe a].cohol:i.c beverages.
Cigarette Wholesale Distributor
Tobacco Proc]ucts Dealers Permit
iCWD
:RTPDP Retail
Additional: Change of Bus.
Annual fee
$140.C~
$196.0~
$280.00
$392.00
$1365.00
$1820.00
$1820.00
$1820.00
$].820.00
$400.00
$400.00
$400.00
$1250.00
$4000.00
$500.00
Name $10.00;
SSo.oo
Change Location $35.00
PASSED AND ADOPTED this __ day of October, 1999.
CITY OF BOYNTOI~ BEACH, FLORIDA
Mayor
Vice Mayor
Mayor Pro Tem
Commissioner
Commissioner
City Clerk
(Corporate Seal)
s:ca\Reso\Links 2 COP Lic App
DBPR FOR,".! ABT 4000-063L
Rev 6/98
STATE OF FLORIDA
Department of Business and Professional Regulation
Division of Alcoholic Beverages and Tobacco
ADM~'ISTRATIVE ESCROW REQUEST
and operating u~der License Number ~0~')/~-)~t2~ ,~ does not hav~ fi~t of ~cup=cy to
~efonow~gloeation: ~g~ ~ ~
(Address)
The above location has been lea~ed to
dokig business as
effegtive
We request that License Number ~lp~)X~)(D~ ~ ~ be removed from the above location and
placed in administrative escrow by the Division of Alcoholic Beverages & Tobacco so that our tenant can obtain a
new alcoholic beverage license and/or tobacco permit.
Signature of Landlord or Rental Agent
Co npany
R~O 87~D
APPROVED AS lC ?,;'::: A, D ·
I~'GAL ,~U F FIGfE~'~d ,'
T. ri!, Il, ,rlN R~O 872D
APPROVED AS TO FORM ~ND
LE~3AL SUFFICIENCY
Location Address:
STATE OF FLORIDA
DEPARTMENT OF BUSINESS REGULATION
DIVISION OFALCOHOLiCBEVERAGES AND TOBACCO ~.~,
License Number:
Date:
LIST OF LICENSE APPLICATION REQUIREMENTS
FOR
New
Transfer
Increase in Series
( ) Decrease in Series ( ) Change in Officers
( ) Change in Series ( ) Other
( ) ChangC in Business Name ( ) TypeLicense~x~C-~
Based on the information you have supplied, the following checked items must be completed and
furnished in order for th~ Division of Alcoholic Beverages and Tobacco to accept your application for pro-
eessing. Incomplete applications will not be accepted for processing.
Application for Alcoholic Beverage License (DBR 424301) must be filed in duplicate with original
$igna ,ages, and must include:
.~.~x?~_. }Sales Tax Clearance Zoning Approval
,.,.x(. ) Health Approval
..,. ~ ) Federal Employer's Identification Number
'-(- ) Sketch of Premiscs to be Licensed
"'~' ) F'mancial Disclosure -'DocuMents
Verifying Funds Invested in Business
'"~) Affidavit bfApplicant
'-,~( ) Affdavit of Seller
Personal Ouestionnaires (DBR 42-008'~
Must be filed in duplicate with the ori~nal signatures for each applicant or persons connected directly
with the business, unless they are current licensees. This will normally include the sole proprietor, al1
general partners, all officers, directors, and shareholders of non-public corporations and the general
panners of limited partnerships. Directly interested persons include anyone that is cqnnected with
the business who has beneficial interest.
DBPR FORM AB"f 4000-037L DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
Rev. 9/99 DMSION OF ALCOHOLIC BEVERAGES AND TOBACCO
APPLICATION REQUIREMENTS
Applications for alcoholic beverage licenses, cigarette wholesale distributor permits, and retail tobacco products de:
permits are fried with the Division of Alcoholic Beverages and Tobacco. These applications must be submitted in
duplicate (1 original and 1 copy is acceptable) and must be typed or neatly and legibly printed in ink. Ail signatures
must be original. Incomplete or illegible applications will not be accepted. We encourage ail applicants to use the
appointment system to turn in applications. At the'appointment, the application will be reviewed and accepted if it is
complete, and f'mgerprints will be taken. If eligible, a temporary license and/or permit may be purchased.
Applications dropped off or mailed in may not be processed on the same day as received, however, they will be
reviewed within 7 working days. You will be notified in writing ff any additional information is needed. When you
have completed the alcoholic beverage license/permit application and obtained ail of the required approvals, you will
need to do one of the following:
1. Call the district office serving your area of interest to make an appointment.
2. Drop off the application.
3. Mail in the application.
**NOTE** Florida law prohibits transfer applicants from assuming operation of a licensed establishment and
selling alcoholic beverages prior to obtammg a temporary or permanent license m the transferee s
ualne.
HEALTH APPROVAL: Health approval is required on all applications for consumption on the premises. Businesses that
serve food or, are located on a premises licensed by the Division of Hotels and Restaurants must obtain approval from that
division. Businesses that do not serve food must contact the County Health Authority or the Department of Health. Food'-~.~ ,,~
service establishments located in grocery and convenience stores, bakeries or delicatessens must contact the Department O
Agriculture and Consumer Services.
ZONING APPROVAL: Zoning approval is executed by the city or county zoning authority in which the business to be
licensed is located. Zoning approval is required on all new and change of location applications unless the applicant is a state
college or university located on State owned property. Zoning approval may also be required for certain change or increase
in series applications. Zoning approval is not required on new applications for lAPS licenses unless required pursuant to a
Special Act.
DEPARTMENT OF REVENUE CLEARANCE: Department of Revenue clearance is required on applications for all new, transfer, change
of location, and correction of information applications Which change the licensee's name.
Contact the Department of Revenue at ( )
AFFIDAVIT OF APPLICANT: Read and sign in the presence of a notary. The affidavit must be signed by the individual
applicant; all parmers of a general partnership; all general partners of a limited partnership; or one of the officers of a
corporate applicant.
AFFIDAVIT OF SELLER: The affidavit of seller must be completed for all transfer applications. The affidavit must be
~igned by the individual owner; all partners of a general partnership; all general partners of a limited partnership; or a
corporate officer of record. If the transfer is pursuant to operation of law or judicial proceedings, certified copies of court
order(s) in which the applicant is named may be accepted in lieu of signature(s) of seller.
~: Fingerprints must be submitted by all individual applicants, panners, corporate officers, stockholder?
owning .5 or more percent of stock, directors, and all general partners of a limited partnership. Fingerprints will be take
the time of submission of a completed application and the $39.00 processing fee is payable by cash, check or money orde~
Fingerprinting by other law enforcement agencies must be taken on fingerprint cards provided by the division. If it is mor~
convenient for you to be fingerprinted at a district office other than where the application is being made, you must call that
office for an appointment.
PERSONAL OUESTIONNAIRE: A personal data for parmer-officer-stockb-older must be filed in duplicate with original
,signatures for each applicant or person(s) directly connected with the business unless they are current licensees. This will
include the sole proprietor; all partners; officers; directors; individual Share holders owning more than .5 % of stock in non-
public corporations; general partners of general partnerships; general partners of a limited partnersh, ip;' a,n.d, the managing,
'¥s of a limited liability company. Directly interested persons include anyone that is connecteu wire me business WhO
ha~ ~eneficial interest. It is important that each individual disclose any arrests they have had, even if they were
cha~ ~ed, but not formally arrested, and REGARDLESS OF TIlE DISPOSITION.
SOCIAL SECURITY NUMBER: Under the Federal Privacy Act, disclosure of Social Security numbers is voluntary unless
a Federal statute specifically requires it or allows states to collect the number. In this instance, disclosure of social security
numbers is mandatory pursuant to Title 42 United States Code, Sections 653 and 654; and sections 409.2577, 409.2598, and
559.79, Florida Statutes. Social Security numbers are used to allow efficient screening of applicants and licensees by a Title
IV-D child sUpport agency to assure compliance with child support obligations. Social Security numbers must also be
recorded on all professional and occupational license applications and are used for licensee identification pursuant to the
Personal RespOnsibility and Work Opportunity Reconciliation Act of 1996 (Welfare Reform Act), 104 Pub. L.193,Sec. 317.
The State of Florida is authorized to collect the social security number of licensees pursuant to the Social Security Act, 42
U.S.C. 405(c)(2)(C)(I). This information is used to identify licensees for tax administration purposes.
..~: Surety bonds are required on all new applications for mannfactnrers, wholesale distributors of alcoholic
beverages, whplesale distributors of cigarettes, other tobacco products, importers and broker sales agents. A surety bond or a
rider to the or!ginal bond must be submitted on any change of business name, change of location'or change of ownership
name applicatil~n by the aforementioned. Contact the Division's district auditing office serving your area of interest for
further information.
ALCOHOL SURCHARGE ELECTION FORM: Vendors licensed under the beverage 'law to sell alcoholic beverages at
~i~,l~and for ~onsurnnfion on the vremises are required to select a method of calculation for the payment of surcharge.
s-e'~ ma~ select ~he purchase'method or sales method. Contact the Division's district auditing office serving your area
arest for !further information.
CORPORATE AND LIMITED PARTNERSItlP REGISTRATION: All corporations, domestic or foreign; general
partnerships; ~imited liability corporations; and limited parmerships are required to be registered with the Florida Secretary of
State, Divisiofi of Corporations. If you have not already registered, you will need to contact the Department of State at (850)
488-9000 for further information. Your application cannot be accepted by this Division without this registration.
FEDERAL EMPLOYER'S IDENTIFICATION NI.rMBER (FEINt: All licensees who pay wages to one or more
employees mdst have a Federal Employer's Identification Number. Contact the internal Revenue Service (IRS) at 1-800-829-
3676 and reqdest Form #SS4.
BUREAU OF ALCOHOL. TOBACCO AND FIREARMS REGISTRATION: Businesses selling alcoholic beverages are
subject to the Federal "Special (OccupaUonal) Tax". This tax is due before the commencement of busmess. The fee is
$250.00 per ~ear for retail dealers and $500.00 per year for wholesale dealers. For more information contact your nearest
BATF regional office.
OUOTA TR)~NSFER FEE: The transfer fee on quota liquor licenses is assessed on the average annual value of gross sales
of alcoholic l~everages for the three (3) years immediately preceding transfer or from the date transferor acquired~the lice..nse
if less than three (3) years. The fee is levied at the rate of four mils and in no event exceeds $5000.00. In lieu ot proviamg
records for c~mputation of the transfer fee, the applicant may elect to pay the $5000.00. The following are acceptable
records for c~mputing the transfer fee:
1.~ '~epartm~nt of Revenue sales tax records.
~ dstribut0r records.
dash re~,i~ter receipts, bank records, accounting records and income tax records.
· 7 'on a notarized affidavit of transferor estimating a percentage
In addition to documentati , of gross alcoholic beverage
4. sales w~en gross sales do not show a breakdown.
C~: Applicants for club licenses, other than fraternal organizations, must submit club by-laws, and articles
of incorporation.
FINANCIAL DOCUMENTATION: Documentation of finances is required for each person or entity having an interest
this business, i.e. copy of loans (whether they are from a traditional lending institution, family member, or friend), gift
affidavit, 3 months of bank statements, etc.
**NOTE**
When applicable you must submit two legible copies of the following: Lease, Pumhase Agreements,
Franchise Agreements, Management Contracts, Service Agreements, and any Agreements which require a
percentage payment from the business operation; Certified Copy of Death Certificate; Letters of
Administration; Certificate of Title; Certified Copy of All Court Orders pertaining to the alcoholic beverage
license.
.qK'I~.TCH OF PREMISES: Draw, in ink, a complete sketch of the premises which includes all walls, doors, counters, sales
areas, storage areas, etc. See example below.
La~ies [ Mens
Room Room
Storage
Kitchen
Back Door
Seating Area
Bar
Office
Patio
BPP- FORM ABT 4000-00IL STATE OF FLORIDA Rev 5/99
Department of Business and Professional Regulation
Division of Alcoholic Beverages and Tobacco
LICENSE/PERMIT APPLICATION
ase read the instructions before completing this application
SECTION I- LICENSE hNFORMATION BUSINESS TELEPHONE
A. TY'PE OF LICENSE: Check Appropriate Boxes
etafl Alcoholic Beverages
eer/Wine/Liquor Wholesaler
lcoholic Beverage Importer/Exporter
U Alcohoiic Beverage Manufacturer
--~ Retail Tobacco Products
~_~1 Cigarette/Tobacco Wholesaler
~_~1 Tobacco Exporter
Cigarette Dis~:ibuting Agenl
Change of Location
Change of Business Name
Change, of Officers/Stockholders
B. TYPE OF APPLICATION: Check Appropriate Boxes
Change in Series
Decrease in Series
Increase in Series
Correction
Series requested:
Do you wish to purchase a temporary? YES __
1.
Type requested: [ ~' C
NO ~ Corporate Document #
FullNameofApplicant: 0 ['~\ OJ~ ~'-'~'.'~'~"x~'~ ~-'~9,-C ~
(If this is a ~o¢oration or oth~ le~l enti~ enter the name as registered with Secmm~ of Smtel Enter document ~ above
6. Enter FeOeral Employer ID# or SS#: FEIN#: ,~--C~ _ ~p~('-,f~ ~ ~ ~
If application is for a NEW license/permit, question 7-8 are not applicable.
~'~, Current ]License Number: Series:
Current [Business Name:
Zip Code:
Zip Code:
SS#:
Type:
¸9.
Is the tr~tnsfer of tins hcense due to revocatton proceedings?
If yes, iS there any personal relauonship to the transferor.
Explainlthe relationship:
SECTION H - DESCRIPTION OF PREMISES TO BE LICENSED
A. Is the proposed premises MOVABLE or ABLE TO BE MOVED? ........................ YES
B. Is the proposed premises located in a shopping center, mall or office building? ..... YES
C. Is there any access through the premises to any area over which you do not have
domin/on and control? ............................................................................................. YES
NO
NO
NO 'X
D. Is the premises occupied by anyone not listed on this application? ....................... YES
NO X'
E. Neatly draw a floor plan of the premises in INK, including sidexvalks and other outside areas which are
contiguous to the premises, walls, doors, counters, sales areas, storage areas, restrooms, bar locations and any
other specific areas which are part of the premises sought to be licensed. A multi-story building where the
entire building is to be licensed must show each floor plan.
~9'~ ,,
PAGE 2
SECTION III - SALES TAX - To be completed by the Department of Revenue.
Thee named applicant for a license/permit has complied with Florida Statutes concerning registration for Sales and Use tax.
This is to verify that the current owner as named in this application has filed all returns and that all outstanding billings and returns
appear to have been paid through the period ending or the liability has been acknowledged and agreed to be
paid by the applicant. This verification does not constitute a certificate as contained in Section 212.10 (1), P.S. (Not applicable if
no uansfer involved.) ..... m,,liad ,-,;*~' ~:~,,,4aa Statutes concemia~ registration for
2. Furtherm°re, the named applicant for an Alcohohc Beverage ~manse nas co-~v ...............
Sales and Use Tax, and has paid any applicable taxes due.
Department of Revenue Stamp
Signed: ~
Tire:
Date:
SECTION IV - ZONING - To be completed by the Zoning Authority governing your business location.
Street Address:
i State: Zip Code:
q~i,. ! ,... · ~A_ ,~ '~o"ance of an alcoholic beverage license where zoning appro.v, al is required, ~e.
· AI mis application is JUl m~ t~u ,, ,
z.°ning ~Uthority must complete "A" and B . If zoning approval is not required, the apphcant must comptere
. ~sectjon
A. The location complies with zoning requirements for the sale of alcoholic beverages or wholesale tobacco
prodhcts pursuant to this application for a Series. alcoholic beverage or wholesale tobacco license.
Signed: ! Title: Date:
~+ ation within the limits of an "Incorporated City or Town? YES [ ] NO [ ]
B. Is lo,c,
If YES , enter name of City or Town .......................... :......i ....... ; ..............
Autho ~ty or Department of Heal~ or me ~epartmCm o~,,
applicable.
AddresS:
The abbve establishment Complies with the requirements of the Florida Sanitary Code.
Signed:I Date:
Title:
Agency:
PAGE 3
SECTION VI
These questions must be answered about this business for every person or entity listed. Copies of agreements
and documentation to support the financial arrangements must be submitted with this application.
1. Is there a management contract or service agreement in connection with this business? YES
2. Are there any agreements which require a payment of a percentage of gross or net receipts from the
business operation? YES __
3. Have you or anyone listed on this application accepted money, equipment or anything of value in
connection with this business from any source connected with the alcoholic beverage industry? YES __
4. Do you have a loan from a source other than a traditienal lending institution?
If yes, what is the source? YES __
5. If purchasing the business, what is the purchase price? ..............................................................................
6. List the total investment, .............................................................................................................................
SECTION VII
Has the applicant corporation been convicted of a felony in this state, any other state, or by
the United States in the last 15 years? YES NO
If the answer is "YES", please list all of the particulars including the date of cenviction, the crime for which the corporation was
convicted and the City, County State and Court where the conviction took place.
Attach extra sheets if ne(~.~alW ..... ~
SECTION VIII ~and wine lic~
[~ Quota Alcoholic Beverage License ] [ Special Alcoholic Beverage License
This license is issued pursuant to -
requirements must be met and mammm,u.
[~ Club Alcoholic Beverage License
,Florida Statute or Special Act and as such we acknowledge the following
PLEASE INITIAL AND DATE:
Applicant's Initials:
PAGE 4
SECTION IX
A. List below the names, titles and interest for ali officers, directors, stockholders, limited partners and general partners of the corporation or
other legal entity for Which this license or permit is being sought. At~ach extra Sheets if necessary.
ITLEfPOSITION NAME STOCK %
President:
Vice President:
Secretary:
Director(s) ( Stockholder(s):
Bar Manager (if Applicable):
B. List below the names and type of interest (~.e. tender, joint account hotder, co-s~gner) for all persons or ent~t~es not hsted ~n Pan
who ha
NAME
(A) above,
~e an interest, directly or indirectly, in this application or the business for which the license/permit is sought. This may include a
corporations, or any form of entity which is connected with this business.
TYPE OF INTEREST
PAGE 5
TRADE NAM~ (D/B/A):
APPLICANT NAME:
AFFIDAVIT OF APPLICANTS
"1 th~ undersio'ned individuallv, or if a comoration for itself, it's officers and dire~ors hereby swear or affirm that I am duly authorized to
make the above and foregoing app!maUon an~, as such I hereby swear or affirm th.? the att~coh,?d sketch or b!uepnnt is s.ubsta, ntlally, a .true
correct re resentation of the premises to be licensed and agree that the place of 15uslness, ir hcenseu, may oe mspectea ana searcneo our~
business hours or at anytime business is bemg conducted on the premises vathout a search warrant by officers of the Division of Alcohq
Beverages and Tobacco, the Sheriff, his Deputies, and Pohce Officers for the purposes of determining compliance with the beverage
cigarette laws.
I swear under oath or affirmation under penalty of perjury as provided for in Florida Statutes 559.791,562.45, and 837.06, that the foregoing
information is tree and that no other person or entity except as indicated herein has an interest in the alcoholic beverage license and/or
cigarette permit and that all of the above listed persons or entities meet the qualifications necessary to hold an interest in the alcoholic
beverage license and/or cigarette permit."
STATE OF
APPLICANT (Signature Must be Notarized)
COUNTY OF
APPLICANT (Signature Must be Notarized)
The foregoing was Sworn to and Subscribed OR ( Acknowledged Before me this __Day of
By , who is ( ) personally known t9 me OR ) who produced
as identification.
Commission Expires:
Notary Public
AFFIDAVIT OF SELLERS
"I, the undersigned, hereby swear or affirm that I am duly authorized to make this affidavit and do hereby consent, on my behalf or on,.~
behalf of the seller, to the above transfer, and represent to the Division of Alcoholic Beverages and Tobacco that the license which is bei
transferred is as shown in the application and that a bona fide sale in good faith has bean made to the within applicant of the business
~vhich the foregoing transfer of license is sought." --
STATE OF
SELLER OR AUTHORIZED OFFICER (Signature Must be Notarized)
COUNTY OF
The foregoing was
By
Sworn to and Subscribed OR (
SELLER OR AUTHORIZED OFFICER (Signature Must be Notarized)
Acknowledged Before me this Day of
,who is ( ) personally known to me OR ) who produced
as identification.
Notary Public
Commission Expires:
FOR DIVISION USE ONLY - DO NOT WRITE BELOW THIS LINE
District Office Date Stamp
CODE: City County
FEIN NUMBER
TYPE: FEE:
Total:
Unaudited:
Approved by: Date: Audited:
PAGE 7
CURRENT LICENSEE UPDATE DATA SHEET
To be completed for all current license holders listed on the application
NAME:
Last
DATE OF BIRTH / /
Mo. day
CURRENT RESIDENCE ADDRESS
yr.
First Middle
SOCIAL SECURITY # / /
City
CURRENT LICENSE NUMBER(S)
State
NAME:
Last
DATE OF BIRTH / /
Mo. day
v v'RRENTiRESIDENCE ADDRESS
yr.
First Middle
SOCIAL SECURITY # /
CURRENT LICENSE NUMBER(S)
State
/)
NAME:
Last
DATE OF BIRTH / __ /
Mo. day
CURREN'~ RESIDENCE ADDRESS
yr.
First Middle
SOCIAL SECURITY # / /
~ City
IRREN~ LICENSE NUMBER(S)
State
/)
/)
Zip
PAGE 8
61A-I.017 Moral Character.
(1) For purposes of the Beverage La'v, a person of "good moral character" shall mean a person who:
(a) Has the ability to distinguish between right and wrong and the character to observe the difference;
(b) Observes the rules of right conduct; and
(c) Acts in a manner that indicates and establishes the qualities of trust and confidence that is generally
acceptable to the state.
(2) Conduct that does not establish the qualities of trust and confidence include the following:
(a) Being penalized for a criminal act in this country or a foreign country that is punishable bY
imprisonment for a term exceeding 1 year when the act is related to alcoholic beverages, failure to pay
taxes, unlawful drugs or controlled substances, prostitution, or inji~ring another person in the preceding
15 years;
(b) Committing two or more crimes in this ~'ountry or a foreign country that are punishable by
imprisonment for a term exceeding 1 year, unless found not guilty by a court of competent jurisdiction,
during the preceding 5 years;
(c) Committing an unlawful lewd, lascivious, or indecent assault or act upon or in the presence of a person
under the age of 16, unless found not guilty by a court of competent jurisdiction, during the preceding 5
years;
(d) Having a delinquent child support obligation which has resulted in issuance of a court order for
collection within the preceding 5 years;
(e) Committing two or more acts of prostitution or lewdness, unless found not gfiilty by a court of
competent jurisdiction, during the preceding 5 years;
(f) Committing an act of unlawful battery, unless found not guilty by a court of competent jurisdiction,
during the preceding 5 years;
(g) Committing an act of selling, delivering, giving, or possession with the intent to sell, give, or deliver
unlawful controlled substances or drugs, unless found not guilty by a court of competent jurisdiction,
during the preceding 5 years;
(h) Committing two or more acts in viol.ation of alcoholic beverage laws, unless found not guilty by a cou
of competent jurisdiction, during the preceding 5 years; ~__
(i) Committing perjury or giving false information under oath to a government agency or court, unless
found not guilty by a court of competent jurisdiction during the preceding 5 years;
0) Engaging in a pattern of fraud as defined in section 409.327, Florida Statutes, unless found not guilty
by a court of competent jurisdiction during the preceding 5 years; and
(k) Having had an ownership interest or managed a business whose alcoholic beverage license or permit
was revoked bY a government agency for a violation ora criminal law that is punishable by
imprisonment for a term exceeding i year, or fourv olations of the same law during the preceding 3
years. . - .4 · ,
(3) Mitigation the d~v~s~on w~ cons ~er n determ n ~g a person s good moral character when there is
evidence of the conduct described in subsection (2) of this rule includes:
(a) An affidavit explaining the circumstances of past conduct and evidence of the qualities of trust and
confidence, the ability to distinguish between right and wrong, and the character to observe the
difference; and
(b) Character references from people who have personal knowledge of the applicant's or licensee's
qualities of trust and confidence, the ability to distinguish between right and wrong, and the character to
observe the difference. References may not include spouse, sons, daughters, or any one employed by
the applicant or licensee.*
(c) Evidence of good citizenship and improving the quality of life in their community.**
**Applicant tnust also provide a copy of the arresting agency's arrest report**
This rule applies to all arrest dispositions except NOT GUILTY (actual finding of Not Guilty by a judge or a jury) hud ~ ~.~,
NOLLE PROSSED (state attorney's office declined pro~cution). · .
*Employees include your attorney, accountant, bar3:er, or anyone you pay to provide a service to you.
**Evidenc~ of good citizeuslfip, etc.: i.e. letters from civic or charitable organlzado~s, churcli, social clubs, etc.
' DEPARTMENT OF BUSINESS & PROFESSIONAL REGULATION
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
1940 North Monroe Street-Tallahassee, Florida 32399-1022
ELECTION OF SURCHARGE CALCULATION METHOD AND INVENTORY REPORT
This application is for a: ~ New License [] Transfer of a License
I hereby elect to pay future surcharges based on the: [] PURCHASE METHOD [] SALES METHOD
Applicant's Name:
Business Name: -'~
Mailing Address:
Location Address: ~C5o'~O '~'C*c~ r~OC~
,FL
Alcoholic Beverage License Number:
Series:
,FL County.~_n
Zip:
Applicant k Signatare
Title Date
Applicantl Name:
Business Name:
Former owner certifies that the U] Purchase method
[] Sales Method
was used to calculate the beverage surcharge and that
all surch; rges have been paid as of
FOR LICENSE TRANSFERS
LicenseNumber:
License Series:
New owner and former owner certify that the following inventory
is being transferred for consumption on premises:
Gallons of Draft Beer
Gallons of Packaged Beer
Gallons of Coolers
Gallons of Wine
Gallons of Liquor
Signature of Former Owner
Date
Signature of New Owner/Applicant
Date
BPR 44-005Ez
REV. 7/95
DBPR FORM ABT 4000-052L
Rev 6/99 STATE OF FLORIDA
DEPARTMENT OF BUSINESS & PROFESSIONAL REGULATION
Division of Alcoholic Beverages and Tobacco
LICENSE/PERMIT APPLICATION WAIVER
Please check appropriate box:
[]90 Day Waiver
[-'] 180 Day Waiver (New Quota Issuance Only)
Chapters 120 and 561 of the Florida Statues require your application be processed
within 90 or 180 days. The Division of Alcoholic Beverages and Tobacco may be unable to
meet the time requirements in your case. Therefore, the Division requests you waive the
time requirements for processing your application. Your application will be processed as
expeditiously as possible.
If you wish to waive the above limitations, please complete the following:
Business Name:
Applicant's Name:
Business Address:
Street Number
Telephone No.:
City County Zip
I do hereby waive all time restrictions surrounding the processing of the above
.referenced application. I do so knowingly and voluntarily.
Date
Signature of Applicant
Your Full Name:
3. Social SecurityNumber: II [ I ]]'1 I ['[] [ [ [[ Home PhoneNumber: [[ [ [ I']l ] ] [[-[[ [ ] [ [[
4. Date ofBirth:mm/dd/yy: 1~[-~[~]-~__~ Place of Birth:
Race: Sex: Height:. Eye Color: Hair Color:
5. Are you a U.S. citizen? YES N If NO, immigration card number or passport #
6. Complete home address (City, St., Zip)
7. Your relationship to the business: ~] Sole owner [~[ Parmer
If corpora((ion: D Director ~] Officer (Title)
DOther
~---]Sha~eholder (% owned)
Do you c~rrently have interest in any business selling alcoholic beverages or wholesale cigarette or tobacco products?
If yes, D/B/A-Business name, location and license number.
Yes0
Have you lever had any type of alcoholic beverage cigarette or tobacco permit refused, revoked or suspended
~ . ' Yes
· ANYWHERE in the past 15 years?
If yes, D/B/A-business name, location, and date.
lO. Have you ~een convicted of a felony, a crime involving moral turpitude or an offense involving alcoholic beverages anywhere?
Yes No If yes, date, location, and type of offense on a separate sheet of paper and provide a
CERTIFIED COPY OF DISPOSITION.
If yon art a convicted felon and have had your civil rights restored in Florida, ATTACH A CERTIFIED COPY
11. Have you [had any criminal charges filed against you within the past 15 years?
YesD ] No [~] If yes, date, location, and type of offanse on a separate sheet of paper.
12. Have you ever been arrested or issued a notice to appear in any state of the United States or it's territories?
Yes [~i NoD If yes, date, location, and type of offanse on a separate sheet of paper.
13. Are you a~ official with State police powers granted by the Florida Legislature? Yes N No N
If yes, please provide the details. II II II }1
What is th}e amount and source of your investment? Documentation must be provided.
"I swear ahd affirm under penalty of perjury as provided for in 559.791, 562.45 and 837.06, Florida Statutes
that the fqregoing information is true and correct."
ate: iD Produced:
Personally known to me [ ]
Notary Public Stamp/Seal
(Signature iof applicant)
PAGE 6
DBPR FORM ABT 4000-026/.,
Rev. 4/99
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
Division of Alcoholic Beverages and Tobacco
AFFIDAVIT
In compliance with Florida Beverage Laws and Regulations I hereby certify
Name:
First Middle Last
Complete Home Address:
was t'mgerprinted by me for the Florida State Division of Alcoholic Beverages and Tobacco, and
that the attached f'mgerprints are his]hers.
Officer Name and Badge Number (please print)
Signature of OffiCer
Depa~:hiient