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APPLICATION FOR RENEWAL OF RETAIL LIQUOR, BEER & WINE LICENSE FOR THE CITY OF BURLEY RENEWAL ONLY THE UNDERSIGNED HEREBY MAKES APPLICATION TO THE CITY OF BURLEY, IDAHO, FOR THE FOLLOWING LICENSES TO SELL ALCOHOLIC BEVERAGES BY THE DRINK FOR THE YEAR . ( ) BEER LICENSE ( ) WINE LICENSE ( ) LIQUOR LICENSE Applicant is the holder of a state of Idaho Beer License No. _ Dated the Day of , _ . Applicant is the holder of a state of Idaho Liquor License No. Dated the Day of , _ . LICENSE FEE FOR BEER LICENSE ENCLOSED $ . LICENSE FEE FOR WINE LICENSE ENCLOSED $ . LICENSE FEE FOR LIQUOR LICENSE ENCLOSED $ . APPLICANT IS: ( ) INDIVIDUAL ( ) CORPORATION ( ) PARTNERSHIP (CHECK ONE OF THE ABOVE) NAME OF APPLICANT NAME OF BUSINESS MAILING ADDRESS OF BUSINESS LOCATION OF PREMISES STREET ADDRESS CITY COUNTY CONTACT PHONE NUMBER _ APPLICANT HERBY CERTIFIES THAT THERE HAVE BEEN NO CHANGES IN THE ABOVE NAMED BUSINESS, OWNERSHIP, DIRECTIONS, STOCKHOLDERS, OR PARTNERS DURING THE PAST LICENSED YEAR, EXCEPT APPLICANT HEREBY AFFIRNS THAT IT IS ELIGIBLE AND HAS NONE OF THE DISQUALIFICATIONS FOR A LICENSE AS PROVIDED BY TITLE 23, CHAPTER 9 AND 10, IDAHO CODE AND ANY AMENDMENTS THERETO, AND MINIDOKA COUNTY APPLICANTS ADDITIONALLY TITLE 23, CHAPTER 13. INCLUDE A COPY OF YOUR UPCOMING STATE AND COUNTY LICENSES FOR OFFICE USE CITY RECEIPT # DATE APPLICANTS SIGNATURE STATE # PRINT NAME_ CASSIA/MINIDOKA COUNTY TITLE _ CITY # DATE _ DISAPPROVED DATE ISSUED_ BEER LICENSE WINE LICENSE LIQUOR LICENSE SIGN ---PAGE BREAK--- Bottled & Canned, OFF SALE $ 50.00 per year Annual $ 100.00 $562.50 per year Draft Beer, Bottled or Canned, $ 200.00 per year Nine Months Six Months $ 75.00 $ 50.00 (includes Wine) ON SALE Three Months $ 25.00