RENEWAL LIQUOR LICENSE APPLICATION

RENEWAL LIQUOR LICENSE APPLICATION
BUSINESS INFORMATION
Business Name*
Business Address*
Business Telephone*
Email*
example@example.com
LICENSE CLASSIFICATION
Renewal License Classification(s) - Mark all that apply*

Class A LicenseClass M LicenseCatering Endorsement
Type of Business Ownership*

Sole ProprietorPartnershipCorporationLLC
CORPORATE OR LLC
Corporation or LLC Name*
Registered Agent Contact
Corporate HQ Address (if applicable)
Business Telephone*
Identify any assumed name (d/b/a)
Corporations/LLC, give the NAMES and ADDRESSES of officers, directors, members and shareholders or partners below with TITLE/PERCENTAGE OWNED. *
Since your last liquor license renewal filing, has any person acquired more than 5% ownership in the corporation or if LLC do you have any members added or removed?*

YesNo
Is the business currently in good standing with the State of Illinois?*

YesNo
For Corporations and LLC's - Please attach a copy of the current Annual Report with the Illinois Secretary of State.

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MANAGER INFORMATION (if applicable)
Manager Name
Manager Home Address
Manager Telephone
Manager Email
example@example.com
Manager Date of Birth

MonthDayYear
Date
Manager Date of Hire

MonthDayYear
Date
LIQUOR SERVICE
Nature of Business:*

RestaurantTavernStoreBowling AlleyGaming ParlorOther
RENEWAL LIQUOR LICENSE APPLICATION
Business Hours -Open At:*
Business Hours - Close At:*
Any outside beer garden or patio? If yes, give square footage.*
LEASE
Does the licensee of the liquor establishment lease the premises on which the business is conducted?*
If leasing, please provide expiration date of lease.

MonthDayYear
Date
If your current lease is not on file with the City, please upload.

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LIQUOR LICENSE BACKGROUND
Have any managers, owners, partners, shareholders or LLC members with more than 5% ownership interest been arrested since the last application? * . If YES, describe the charge, the date, the city and state where the charge was brought, and the disposition * .
Has any action been initiated by any jurisdiction against the licensee, the business, manager, agent, or employee for violation of any law with respect to the service of alcoholic beverages since the filing of the last application of your Liquor License?* . If YES, describe the violation and the results: * .
Does the business operate Video Gaming Terminals on the premises?*

YesNo
DRAM SHOP INSURANCE
Please attach a copy of your DRAM Shop Insurance. Showing liquor liability insurance of not less than $1,000,000.00 per occurence and general liability insurance in an amount not less than $1,000,000.00 per occurrence. Both must name the City of Belvidere as an additional insured.*

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PERSON COMPLETING THIS APPLICATION
Name

First NameLast Name
Title
Address
Telephone
Email
example@example.com
Relationship to Business
Date Signed

MonthDayYear
I, the undersigned applicant or authorized agent thereof, swear and affirm that: The matters stated in the foregoing application are true and correct; They are made upon my personal knowledge and information; They are made for the purpose of requesting the City of Belvidere to issue the license herein applied for; The applicant is qulified and eligible to obtain the license applied for; And the applicant will not violate the laws of the United States of America, the State of Illinois, or the City of Belvidere, in particular, the Illinois Liquor Control Act, Rules and Regulations, and the Civil Rights Sections thereof. Further, I agree to notifiy the Liquor Commissioner in writing within ten (10) days of changes in any of the above information.

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If you would still like to pay with Check or Money Order please click the SUBMIT button above and remit payment to:

City of Belvidere

401 Whitney Blvd.

Belvidere, IL 61008
Should be Empty:

RENEWAL LIQUOR LICENSE APPLICATION

BUSINESS INFORMATION

LICENSE CLASSIFICATION

CORPORATE OR LLC

MANAGER INFORMATION (if applicable)

LIQUOR SERVICE

RENEWAL LIQUOR LICENSE APPLICATION

LEASE

LIQUOR LICENSE BACKGROUND

DRAM SHOP INSURANCE

PERSON COMPLETING THIS APPLICATION