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Effective 07/25/2024 Temporary Alcoholic Beverage Permit Application Licensing Department [PHONE REDACTED] [EMAIL REDACTED] I have read Columbia County Code Chapter 6 Alcoholic Beverages and will maintain a copy of the chapter, the Georgia Alcoholic Beverage Code and any regulations issued under such code on the premises. All requirements of the chapter have been met. The applicant(s), operating manager and all partners, officers, directors, shareholders or any other person required to be listed on the application, even if not required to be a joint applicant, meet the qualifications from Columbia County Code Section 6-50. To my knowledge, all persons having any ownership interest in or control over the land or building containing the establishment to be operated pursuant to the license being applied for, meet the same character requirements as those set forth for the licensee. All taxes or fees due to Columbia County and/or the State of Georgia have been paid. The establishment complies with all applicable building and fire codes and all applicable government laws and regulations. I certify that to my knowledge all of the information contained within this application is true and correct and that I have truthfully and as completely as possible responded to all questions and requirements of this application. Signature of Applicant Date Columbia County Use Only Received Complete: Application: Georgia DOR Confirmation: Criminal History: Venue Occupancy: Approved: County Manager Date Approved: Development Services Division Director Date Applicant This must be a person. If applying on behalf of a business or nonprofit, the person must be an officer with the authority to bind the business or nonprofit. Full Legal Name: Home Address: Phone: Email: Businesses and Nonprofits If you are applying as an individual, do not complete this section. Legal Name: Doing Business As: If applicable, the name used to conduct business when different from the legal name. Physical Address: Phone: Email: Applicant’s Title: Event Name of Event: Type of Event: Start Date & Time: End Date & Time: Alcohol Delivery Date: Physical Address: Expected Total Number of People (include attendees, staff & volunteers): Alcoholic Beverages Alcohol Served (mark all that apply): Beer Wine Distilled Spirits Payment Method: By the drink (cash bar/ticket exchange) Alcoholic beverages included in price of admission or membership Alcohol will be provided by (mark only one): Licensed Alcoholic Beverage Caterer (must be applicant and provide copy of current license if business is outside Columbia County) Applicant Responsibilities and Certification SIGN