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ALCOHOL LICENSE APPLICATION (Beer, Wine, and/or Liquor) 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 NEW APPLICATION RENEWAL PLEASE CHECK ALL THAT APPLY: BEER LICENSE WINE LICENSE LIQUOR LICENSE Bottled & Canned OFF SALE $ 50 per year Annual (per year) $ 100 $562.50 per year (Includes Wine) Bottled & Canned ON SALE $ 200 per year Nine Months $ 75 Six Months $ 50 Three Months $ 25 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 LOCATION OF PREMISES STREET ADDRESS CITY COUNTY PHONE NUMBER EMAIL INCLUDE A SIGNED COPY OF YOUR UPCOMING STATE AND COUNTY LICENSES & SITE PLAN (if applicable) MY SITE PLAN HAS NOT CHANGED FROM MY PREVIOUS SUBMISSION MY SITE PLAN HAS CHANGED, PLEASE SEE THE ATTACHED SITE PLAN APPLICANT HERBY CERTIFIES THAT THERE HAVE BEEN NO CHANGES IN THE ABOVE-NAMED BUSINESS, OWNERSHIP, DIRECTIONS, STOCKHOLDERS, OR PARTNERS DURING THE PAST LICENSED YEAR, 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. APPLICANT SIGNATURE PRINT NAME TITLE DATE FOR OFFICE USE ONLY Receipt Date: State County: Minidoka Cassia County City Date Issued: