Document Dawsoncountyga_doc_3e70f532ae

Revised 7-17-24 1I Page Dawson County Alcohol Licensing 25 Justice Way, Suite 2223 I [PHONE REDACTED] Dear Applicant: Thank you for being part of the Dawson County business community. We welcome the opportunity to assist you in obtaining an Alcoholic Beverage License. In order to streamline the application process, this letter outlines some of the requirements for this license and the necessary forms. The Dawson County Consolidated Alcohol Ordinance adopted and ordained by the Dawson County Board of Commissioners is the authority under which all license applications will be measured. The Dawson County Board of Commissioners will review and determine the approval for all applications for an Alcoholic Beverage License. If you have questions during the application process, please call the Alcohol Licensing Administrator at (706) 531-2306. You may call for assistance Monday through Friday between the hours of 8:00 a.m. and 2:30 p.m. Once you have completed your application, you must call for an appointment to submit the application. The following are included with this letter: 1. Applicant Information and Check List (Form 2. Application for Alcoholic Beverage License (Form 3. Registered Agent Consent Form (Form #2-A) [If Applicable] 4. Premise and Structure Form (Form 5. Certified Report of Survey (Form #3-A) for Alcoholic Beverage License 6. Statement of Personal History Form (Form 7. Affidavit for Issuance of a Public Benefit (Form #4-A) 8. Private Employer Affidavit of Compliance (E-Verify, Form #4-B) 9. Private Employer Exemption Affidavit (E-Verify, Form #4-C) 10. Projected Purchases/Projected Gross Sales (Form [If Applicable] 11. Criminal History Check 12. Excise Tax Reporting Form (Form #6/Form #6-A) [If Applicable] IMPORTANT REMINDERS: Applicant: • Must be at least 21 years of age. • Must be a citizen of the United States, a legal permanent resident of the United Sates, or a qualified alien or non- immigrant under the Federal Immigration and Nationality Act. ---PAGE BREAK--- Revised 7-17-24 2I Page Background Check: All applicants must submit fingerprinting for investigation by the Georgia Bureau of Investigation and the Federal Bureau of Investigation to search for any instance of criminal activity during the two years immediately preceding the date of the application. Application & Related Forms: • The applicant must submit all forms with ORIGINAL signatures on each and notarized where required. Be sure to retain a copy of all application paperwork before submittal. Fees: • All fees are payable to Dawson County and only with CERTIFIED FUNDS. No personal or business checks will be accepted. • If your application is denied, your license fee will be refunded. However, the Administrative/Investigative Fee will not be refunded. • An advertising fee is required for all new licenses. Licenses / Permits / Inspections: Contact Planning and Development at (706) 344-3500 for these requirements. To finalize alcohol license applications, you must provide copies of the following: • Fire Department Inspection • Certificate of Occupancy • Health Department Inspection & Permit (applicable to food establishments) • Department of Agriculture Food Sales Establishment License (Grocery and Convenience Stores only) • Dawson County Business License • State of Georgia Alcoholic Beverage License (after County license is issued) Excise Tax and Food Sales Reporting: • Applies to Distilled Spirits Consumed on the Premises. Upon issuance of your Alcoholic Beverage License, you are required to submit excise tax reports and payments. Failure to do so could result in penalties and possible revocation of your license. All licensees must submit food sales reports. • For Consumption on Premises Licenses, food sales must be at least 50% to alcohol sales. Thank you again for being part of the Dawson County business community. We trust that the application process for your Alcoholic Beverage License will be a pleasant, efficient, and timely experience. Please call us with any questions or concerns. Sincerely, Alcohol License Administration Enclosures ---PAGE BREAK--- Form #1 Revised 6-25-24 1I Page Dawson County Alcohol Licensing 25 Justice Way, Suite 2223 I [PHONE REDACTED] Applicant Information & Check List **IMPORTANT** After being licensed by Dawson County for an Alcoholic Beverage License, you must obtain a state alcohol license before any alcoholic beverage can be served or sold in Dawson County. Contact the Georgia Department of Revenue at (404) 417-4490. ***Provide Copy of State License When Obtained*** Before a new license can be issued, you must contact the following departments for their requirements/inspections: 1. Planning & Development (706) 344-3500 x 42335 Provide copy of Business License 2. Fire Department (706) 344-3666 x 44501 Provide copy of Inspection Report 3. Environmental Health Department (706) 265-2930 Provide copy of Inspection Report 4. Department of Agriculture (food stores only) (770)535-5955 Provide copy of Food Sales Est. License **If your business or proposed business is inside the city limits of Dawsonville, you must apply to the City of Dawsonville for an Alcoholic Beverage License. (706) 265-3256** Please call for an appointment prior to submitting your application for an alcoholic beverage license: (706)531-2306. The following information (where applicable) will be required when submitting your application: • Application Form and all attachments (Form Certified Check for license fees. (Payable to Dawson County) Criminal History Request Form Registered Agent Consent Form. (Form #3-A) [Optional] For bona fide Private Clubs, attach minutes of annual meeting setting salaries for members, officers, agents or employees. For Partnerships, attach Partnership Agreement. For Corporations or LLC's, attach Articles of Incorporation or Organization. For Corporations or LLC's, attach Certificate of Incorporation or Organization ---PAGE BREAK--- Form #1 Revised 6-25-24 2I Page • Premise/Structure Form and all attachments. (Form **Call Planning & Development at (706) 344-3500 x42255 for permits and business license requirements.** If building is completed, attach copy of detailed floor plan. Also, attach copy of site plan. If building is proposed, attach copy of proposed plans and specifications and a building permit for the proposed building. Attach Certified Report of Survey (Form #4-A) from registered land surveyor or professional engineer. Attach certified scale drawing showing location and distance to closest church, school, daycare and alcohol treatment facility. (See survey form for definitions.) For bona fide eating establishments only, attach copy of menu(s). If applicant is a franchise, attach copy of the franchise agreement or contract. For grocery & convenience stores, attach Department of Agriculture Food Sales Establishment License. • Statement of Personal History Form (Form for sole owner, partners, officers, directors, members and major stockholders of corporations or LLC's and general manager. All individuals required to complete Personal History Form must be fingerprinted. Applicant should submit fingerprints to Georgia Applicant Processing Service (GAPS). If the applicant wishes to submit fingerprinting in another state, they must submit to that state's Applicant Processing Center, using Dawson County ORI: GA923216Z Attach Affidavit for Issuance of a Public Benefit. Attach a Secure and Verifiable Document. Attach either a Private Employer Affidavit of Compliance or a Private Employer Exemption Affidavit. Attach copy of Permanent Resident Card and Alien Number (if applicable) for all individuals submitting a Personal History Form. Attach copy of current Driver's License or State Identification Card for all individuals submitting a Personal History Form. Attach photograph on last page of Personal History Form. • Projected Purchases / Projected Gross Sales (Form [Consumption on premises-distilled spirits only] • Excise Tax Reporting Form (Form (to be submitted [Consumption on premises-distilled spirits only] ---PAGE BREAK--- Form #2 Revised 7.08.24 1 I Page Dawson County Alcohol Licensing 25 Justice Way, Suite 2223 I [PHONE REDACTED] Application for Alcoholic Beverage License This application must be signed by the applicant and notarized. Every question must be fully answered with the answer typewritten or printed. If the space provided is not sufficient, answer on a separate sheet and indicate in the space provided that a separate sheet is attached. When completed, the application must be dated, signed, and verified under oath by the applicant and submitted to Planning and Development, together with the license fee(s) and the administrative/investigative fee (separate checks). All fees are payable to Dawson County in certified funds (bank check, certified check, or money order). The applicant must be not less than 21 years of age. NOTICE: Any and all false information provided to the Alcohol Licensing Office verbally or written will subject the person that provides this false information to prosecution to the full extent of the law and will subject the application to denial or revocation. ***KEEP A COPY OF ALL FORMS SUBMITTED*** FOR OFFICIAL USE ONLY: Name of Business: Date Received: License Fee Enclosed: $ Approved: Denied: State License Number: Local License Number: Administrative/ Investigative Fee Enclosed: Fee Enclosed: 1. Type of License: (check one): New Amendment (transfer) 2. Administrative and Investigative Fee $300.00 (Consumption on Premises) Administrative and Investigative Fee $300.00 (Retail Package) Administrative and Investigative Fee $300.00 (Transfer of License) Note: Administrative/Investigative fees may be higher depending on the number of persons for which we conduct a federal and state background check ---PAGE BREAK--- Application for Alcoholic Beverage License Form #2 Revised 7.08.24 2 I Page Advertising Fee: $50.00 (Distilled Spirits) (Consumption on Premises & Retail Package) 3. Type of Business: Eating Establishment Super Market Convenience Store Hotel/Motel Private Club Other Please explain: Will live entertainment be offered? If yes, explain: 4. Type of License and Fees: (Check all that apply) **Payment by certified funds only. If license is issued after July 1st, fees are one half. a) Retail Package: (Total: Beer – Wine – Distilled Spirits = $5,800) (Total: Beer – Wine = $1,500) Beer $1,000 Wine $1,000 Distilled Spirits $4,500 Grocery & Convenience Stores: Attach copy of Department of Agriculture food establishment license. b) Retail Consumption on Premises: (Total: Beer – Wine – Distilled Spirits = $4,800) (Total: Beer – Wine = $1,500) Distilled Spirits $3,300 Additional Fixed Bars # $500.00 (each bar) Beer $1,000 Movable Bars # $200.00 (each bar) Wine $1,000 Wine, Farm Winery, Tasting Room $500 Brewpub $300 Alcohol Beverage Catering $300 c) Hotel In-Room Service: (Must obtain a Retail Consumption on Premise license before Hotel In-Room Service license is issued.) Beer & Wine $100 ---PAGE BREAK--- Application for Alcoholic Beverage License Form #2 Revised 7.08.24 3 I Page 5. Business: a) Business Name: b) Location: Street Number Street Name City State Zip Code Phone Number c) Mailing Address: Street Number Street Name City State Zip Code Phone Number 6. Owner: a) Full Name: Social Security Number b) Corporation or LLC Name (if applicable) c) Location: Street Number Street Name City State Zip Code Phone Number d) Mailing Address: Street Number Street Name City State Zip Code Phone Number 7. Name of Licensee: e) Full Name: Social Security Number f) Location: Street Number Street Name City State Zip Code Phone Number ---PAGE BREAK--- Application for Alcoholic Beverage License Form #2 Revised 7.08.24 4 I Page g) Mailing Address: Street Number Street Name City State Zip Code Phone Number 8. Registered Agent: (Applicant may name a Registered Agent – attach Registered Agent Consent Form # 3-A.) a) Full Name: Social Security Number b) Address: Street Number Street Name City State Zip Code Phone Number 9. Type of Ownership: Sole Proprietorship Legally Registered Partnership Private Held Corporation Public Held Corporation Public Held Corporation Subject to S. E. C. Regulations Limited Liability Company Other; explain: 10. For Partnership Only: a) Date the Partnership was formed: b) Attach Partnership Agreement c) List Partners: (Attach separate sheet if necessary) Name & Resident Address Social Security Number G- General L- Limited S- Silent Investment Participation $ Interest % ---PAGE BREAK--- Application for Alcoholic Beverage License Form #2 Revised 7.08.24 5 I Page 11. For Corporation of LLC Only: (Attach Articles & Certificate of Incorporation/ Organization) a) Date of Incorporation/ Organization: b) Place of Incorporation/ Organization: c) State Parent Corporation, if applicable: d) Number of Shares of Capital Stock, if applicable: e) Number of Shares of Outstanding Stock, if applicable: f) For Corporations of LLC’s, list officers, directors, members, and/or principal shareholders with 20% or more of the stock: Name Social Security Number Position Interest % g) Is the corporation owned by a parent corporation or held by a holding company? If yes, explain: 12. For Private Clubs Only: a) Date of organization under the laws of the State of Georgia: b) State the total number of regular dues paying members: c) Is any member, officer, agent, or employee compensated directly or indirectly from the profits of the sale of distilled spirits beyond a fixed salary as established by its members at any annual meeting or by its governing board out of the general revenue of the ---PAGE BREAK--- Application for Alcoholic Beverage License Form #2 Revised 7.08.24 6 I Page d) Attach minutes of the annual meeting setting salaries. For private club, list officers, directors and/or principal shareholders with 20% or more of the stock. Name Social Security Number Position 13. Financing: a) Bank to be used by business, include branch: b) State total amount of capital that is or will be invested in the business by any party or parties: c) State total amount of funds invested by the Owner: d) State total amount of funds invested by parties other than the Owner: e) If any capital is borrowed, please identify the lender below: Name of Lender Date Amount ---PAGE BREAK--- Application for Alcoholic Beverage License Form #2 Revised 7.08.24 7 I Page 14. General Information: a) Does Owner and/or individual Partner, Shareholder, Director, Officer or Member have any interest in any manufacturer or wholesaler of alcoholic beverage? b) Has Owner and/or individual Partner, Shareholder, Director, Officer or Member received any financial aid or assistance from any manufacturer or wholesaler of alcoholic beverages? c) If answer is "Yes" to either of immediate foregoing, explain: d) On the following page, show hereunder any and all persons, corporations, partnerships, limited liability companies or associations (other than persons stated herein as Owner(s), Director(s), Officer(s) or Member(s)) who have received or will receive, as a result of your operation under the requested license, any financial gain or payment derived from any interest or income from the operation. Financial gain or payment shall include payment or gain from any interest in the land, fixtures, building, stock, and any other asset of the proposed operation under the license. In the event any Corporation or limited liability company is listed as receiving an interest or income from this operation, show the names of the Officers, Directors or Members of said corporation together with the names of the principal stockholders. e) List all other businesses engaged in the sale of alcohol beverages that you the Owner, or any individual, Partner, Shareholder, Officer, Director or Member has interest in, is employed by or is associated with in any way whatsoever, or has had interest in, has been employed by, or has been associated with in the past. ---PAGE BREAK--- Application for Alcoholic Beverage License Form #2 Revised 7.08.24 8 I Page 15. List wholesalers from which the business will procure alcohol: a) In accordance with the Georgia state law, Rule 560-2-3-. 08 Retailer Purchase from Licensed Wholesaler, businesses in Georgia must purchase alcoholic beverages from licensed wholesalers. (To ensure compliance, there will be an opportunity each month on the Dawson County Excise Tax Reporting Form, to identify new wholesalers from which the business purchases alcohol.) Wholesaler’s Name Phone Number 16. For Package Liquor Store Applicants: ***State of Georgia Regulations*** a) The State of Georgia will not issue a State Alcohol License to any person who has more than two retail package liquor licenses. See official language below. Do not apply for a Dawson County License if you already have (or have interest in) two package liquor store licenses in the State of Georgia. O.C.G.A. 3-4-21 and Regulation 560-2-2-40. No person shall be issued more than two retail package liquor licenses, nor shall any person be permitted to have a beneficial interest in more than two retail package liquor licenses issued by the Department regardless of the degree of such interest. For the purposes of explanation and applicability of the Code: "Beneficial interest" as used here means: when a person holds the retail package liquor license in his own name, or when he has a legal, equitable or other ownership interest in, or has any legally enforceable interest or financial interest in, or derives any economic benefit from, or has control over a retail package liquor business. The term "person" shall include all members of a retail package liquor dealer licensee's family; and the term "family" shall include any person related to the holder of the license within the first degree of consanguinity and affinity as computed according to the canon law which includes the following: spouse, parents, step-parents, parents-in-law, brothers and sisters, step-brothers and step-sisters, brothers-in-law and sisters-in-law, children, step-children and children-in-law. b) Do you currently hold any package liquor licenses in your own name or have a beneficial interest in any package liquor licenses as described above? No. If yes, attach a separate sheet listing names, addresses, and license numbers. ---PAGE BREAK--- Application for Alcoholic Beverage License Form #2 Revised 7.08.24 9 I Page NOTE: Before signing this statement, check all answers and explanations to see that you have answered all questions fully and correctly. This statement is to be executed under oath and subject to the penalties of false swearing, and it includes all attached sheets submitted herewith. STATE OF GEORGIA, DAWSON COUNTY I, DO SOLEMNLY SWEAR, SUBJECT TO THE PENALTIES OF FALSE SWEARING, THAT THE STATEMENTS AND ANSWERS MADE BY ME AS THE APPLICANT IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT. APPLICANT’S SIGNATURE I HEREBY CERTIFY SIGNED HIS NAME TO THE FOREGOING APPLICATION STATING TO ME THAT HE KNEW AND UNDERSTOOD ALL STATEMENTS AND ANSWERS MADE THEREIN, AND, UNDER OATH ACTUALLY ADMINISTERED BY ME, HAS SWORN THAT SAID STATEMENTS AND ANSWERS ARE TRUE AND CORRECT. DAY NOTARY PUBLIC ---PAGE BREAK--- Application for Alcoholic Beverage License Form #2 Revised 7.08.24 10 I Page FOR OFFICIAL USE ONLY: COMMUNITY DEVELOPMENT DIRECTOR REVIEW: Date: Applicant has obtained all necessary Permits and Licenses. (Building Permit / Business License) Dawson County Alcohol Administrator Dawson County Community Development Director ---PAGE BREAK--- Form #2-A Revised 07.10.2024 Dawson County Alcohol Licensing 25 Justice Way, Suite 2223 I [PHONE REDACTED] Registered Agent Consent Form Business Name Business Address I, do hereby consent to serve as the Registered Agent for the licensee, owners, officers, and/or directors and to perform all obligations of such agency under the Alcoholic Beverage Ordinance of Dawson County. I understand the basic purpose is to have and continuously maintain a Registered Agent upon which any process, notice, or demand required or permitted by law or under said Ordinance to be served upon the licensee or owner may be served. This day of 20 Signature of Agent Print Name of Agent Print Agent’s Street Address Print Agent’s City – County – State – Zip Code Approved: Sole Owner/Partner Officer or Director Title ---PAGE BREAK--- Form #3 Revised 7.08.24 1 I Page Dawson County Alcohol Licensing 25 Justice Way, Suite 2223 I [PHONE REDACTED] Premise and Structure Form Instruction: This statement must be typewritten or printed and executed under oath. each question must be fully answered. If space provided is not sufficient, answer on a separate sheet and indicate in the space provided that a separate sheet is attached. 1. Type of Business: Eating Establishment Indoor Commercial Recreation Establishment Convenience Store Super Market Package Liquor Store Hotel Or Motel Other 2. Trade Name of Business: Location: Street Number Street Name City State Zip Code Phone Number Land Lot Map and Parcel Number 3. Is this location within a commercial zoning district? (Proof of zoning is required from Planning and Development) a) For package liquor stores, is this zoned Commercial Highway Business (C-HB) or Commercial Planned Comprehensive Development (CPCD) as required by the ordinance? (Proof of C-HB or CPCD zoning is required from planning and development.) 4. Does the completed building or the proposed building comply with ordinances of Dawson County, regulations of the State Revenue Commissioner, and the laws of the state of Georgia? no, explain non-compliance and proposed methods. To rectify same: ---PAGE BREAK--- Premise and Structure Form Form #3 Revised 7.08.24 2 I Page 5. Building Lighting: a) Does the building in which the business is to be located contain sufficient lighting so that the building itself and the premises on all sides of the building are readily visible at all times from the front of the street on which the building is located as to reveal all of the outside premises of such building? b) Is the building so illuminated so that all hallways, passage ways, and open areas may be clearly seen by the customer therein? c) If the answer is no to either or both or above, please explain proposed methods to rectify the insufficient lighting. 6. For Consumption on Premises and Retail Package Applications: (Answer "N/A" for items that are not applicable to your business) a) Number of square feet of total floor area: b) Number of square feet devoted to dining area: c) Seating capacity excluding bar area: d) Do you have a full-service kitchen? e) Does the full-service kitchen contain a three compartment sink? f) Is the stove and/or grill permanently installed and approved by the health and fire departments? g) If the answer to any of the immediate foregoing is no, please explain: h) Hours prepared meals or foods are served: i) Hours that alcoholic beverages are served or sold: j) Hours of operation: k) Maximum number of employees on highest shift: l) Number of parking spaces: m) Number of parking spaces devoted to handicapped persons: 7. Package Liquor Stores: a) Do you comply with ordinance Article 5 Section 503 - Posting of License Number? *Every licensee shall have posted on the front of the licensed premises the name of the licensee together with the following inscription, "County Retail Package Sales of Distilled Spirits License No.” b) Do you comply with ordinance Article 5 Section 505 a) - Types of Outlets Where Package Sales Are Permitted? *Outlets that are devoted exclusively to the retail sale of distilled spirits, malt beverages and/or wine by the package with ingress and egress provided directly to and only to the exterior of the building and not to any other enclosed part of the building or adjoining building. 8. For Hotel/Motel Only: a) Number of rooms available for hire to general public: ---PAGE BREAK--- Premise and Structure Form Form #3 Revised 7.08.24 3 I Page b) Number of square feet of floor space devoted to restaurant: c) Number of square feet of floor space devoted to dining area: d) Seating capacity excluding bar area. (Explain if more than one dining area): e) Do you have a full-service kitchen? Does the full-service kitchen contain a three compartment sink? Is the stove and/or grill permanently installed and approved by the Health and Fire Departments? If the answer to any of the immediate foregoing is no, please explain: f) Hours prepared meals or foods are served: g) Hours that alcoholic beverages are served: h) Maximum number of employees on the highest shift devoted to the operation other than the restaurant: i) Maximum number of employees on highest shift devoted to the restaurant operation: j) Number of parking spaces: k) Number of parking spaces devoted to handicapped persons: 9. For All Applications: Attach a certified scale drawing of the proposed premises by a registered land surveyor or professional engineer, showing the distance requirement from church, school, daycare facility, or alcohol treatment center. (See survey form #4-A) 10. Attach applicant's certification that the location complies with the distance requirement from church, school, daycare facility or alcohol treatment center. (See Survey Form #4-A) 11. Attach evidence of ownership (deed, lease, sales agreement, letter of intent). 12. If the applicant is a franchise, attach a copy of the franchise agreement or contract. 13. If the applicant is an eating establishment, attach a copy of the menu(s). 14. Building Plans: a) If the building is complete, attach copies of detailed site plans of said building including outside premises and floor plan. b) If the building is proposed, attach copies of proposed site plan and specifications and building permit of the proposed building. ---PAGE BREAK--- Premise and Structure Form Form #3 Revised 7.08.24 4 I Page NOTE: Before signing this statement, check all answers and explanations to see that you have answered all questions fully and correctly. This statement is to be executed under oath and subject to the penalties of false swearing, and it includes all attached sheets submitted herewith. STATE OF GEORGIA, DAWSON COUNTY I, DO SOLEMNLY SWEAR, SUBJECT TO THE PENALTIES OF FALSE SWEARING, THAT THE STATEMENTS AND ANSWERS MADE BY ME AS THE APPLICANT IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT. APPLICANT’S SIGNATURE I HEREBY CERTIFY SIGNED HIS NAME TO THE FOREGOING APPLICATION STATING TO ME THAT HE KNEW AND UNDERSTOOD ALL STATEMENTS AND ANSWERS MADE THEREIN, AND, UNDER OATH ACTUALLY ADMINISTERED BY ME, HAS SWORN THAT SAID STATEMENTS AND ANSWERS ARE TRUE AND CORRECT. DAY NOTARY PUBLIC ---PAGE BREAK--- Form #3-A Revised 7.08.24 1 I Page Dawson County Alcohol Licensing 25 Justice Way, Suite 2223 I [PHONE REDACTED] Certified Report of Survey For All Consumption on Premises and Retail Package Establishments The premises to be licensed must comply with the following minimum distance requirements to comply with the Official Code of Georgia 3-3-2; 3-3-21; Reg. 560-2-2-.32; and the Dawson County Consolidated Alcohol Ordinance. Applicant: Business Name: Address of Premises to be Licensed: 1. Church Building: "Church building" means the main structure used by any religious organization for purposes of worship. The premises to be licensed must be a minimum of 600 feet (200 yards) from the nearest church building, measured in a straight line from the front door of the licensed facility to the front door of the church building. County Ordinance References: Article 5 Section 501(A), Article 6 Section 600(B), Article 7 Section 700 Name and Address of Nearest Church: Distance Measured: 2. School Building or School Grounds: "School building or school grounds" shall apply only to state, county, city, or church school buildings and to such buildings at such other schools in which are taught subjects commonly taught in the common schools and colleges of this state and which are public schools or private schools. The premises to be licensed must be a minimum of 600 feet (200 yards) from any school, educational building or college, measured in a straight line from the front door of the licensed facility to the front door of the school, educational building or college. County Ordinance References: Article 5 Section 501(A), Article 6 Section 600(B), Article 7 Section 700(B) Name and Address of Nearest School: Distance Measured: 3. Daycare: "Daycare" means any place operated by a person, society, agency, corporation, institution, or group wherein are received for pay for group care for less than 24 hours per day, without transfer of legal custody, children under 18 years of age, and is not accredited as a ---PAGE BREAK--- Certified Report of Survey Form #3-A Revised 7.08.24 2 I Page public or private school (except that centers offering state funded pre-K programs are still considered daycares). The premises to be licensed must be a minimum of 600 feet (200 yards) from the nearest daycare, measured in a straight line from the front door of the licensed facility to the front door of the daycare. County Ordinance References: Article 5 Section 501(A), Article 6 Section 600(B), Article 7 Section 700 Name and Address of Nearest Daycare: Distance Measured: 4. Alcohol Treatment Facility: "Alcohol treatment facility" means any alcohol treatment center owned and operated by the State or the County government. The premises to be licensed must be a minimum of 600 feet (200 yards) from the nearest alcohol treatment facility, measured in a straight line from the front door of the licensed facility to the front door of the alcohol treatment facility. County Ordinance References: Article 5 Section 501(A), Article 6 Section 600(B), Article 7 Section 700 Note: The only State or County operated alcohol treatment facility is Dawson County Treatment Court, 189 Highway 53 West, Suite 106, Dawsonville, GA 30534. Name and Address of Nearest Alcohol Treatment Facility: Distance Measured: 5. Another Package Store: ***Applies to Package Liquor Stores Only*** No license shall be issued under this ordinance for use at a location which is within one mile (1,760 yards) of any other business licensed to sell packaged liquor (distilled spirits) at retail. This distance shall be measured in a straight line from the front door of the licensed facility to the front door of the other package store. This restriction shall not apply to any location for which a new license is applied if the retail package sale of distilled spirits was lawful at such location during the 12 months immediately preceding such application. County Ordinance Reference Article 5 Section 501(B) Name and Address of Nearest Package Liquor Store: Distance Measured: 6. Housing Authority Property: ***Applies to Alcohol by the Drink Establishments*** There is NO housing authority property in Dawson County. "Housing authority property" means any property containing 300 housing units or fewer owned or operated by a housing authority created under the State Housing Authorities Law. The premises to be licensed must be a minimum of 600 feet (200 yards) from the nearest housing authority property, measured in a straight line from the front door of the licensed facility to the front door of the housing authority property. County Ordinance Reference Article 7 Section 700(B) Name and Address of Nearest Housing Authority Property: in Distance Measured: ---PAGE BREAK--- Certified Report of Survey Form #3-A Revised 7.08.24 3 I Page Note: A scale drawing (by a Georgia Registered Land Surveyor/Engineer) of the location of the premises to be licensed, showing the closest prohibited structures and identifying the minimum distance, must be attached hereto. The License Applicant Completes the Following Certification: The undersigned certifies that subject location is in compliance or non-compliance with the distance requirements set forth above. I have found: (check one) above listed structures are inside the minimum distance restrictions stated above or The premises to be licensed meets the minimum distance requirements for licensing stated above. Applicant’s Printed Name Applicant’s Signature Date of Signature Notary’s Signature Date of Signature ---PAGE BREAK--- Form #4 Revised 7.08.24 1 I Page Dawson County Alcohol Licensing 25 Justice Way, Suite 2223 I [PHONE REDACTED] Statement of Personal History Instruction: This statement must be typed or neatly printed and executed under oath. Each question must be fully answered. If space provided is not sufficient, answer on a separate sheet and indicate in the space if a separate sheet is attached. 1. NAME: Last First Middle RESIDENCE: Street Number Street Name City State Zip Code Telephone Number 2. CHECK: (all that apply)  Sole Owner/Proprietor  Partner:  General  Limited  Silent  Director  Principal Stockholder (20% or more)  Registered Agent  Officer:  Manager  Employee: 3. Trade name of business for which this statement is made: Name of Business: Location: Street Number Street Name P. O. Box City State Zip Code Telephone Number 4. State the percentage of ownership or interest, if any, in this business: 5. State method and amount of compensation, if any, directly or indirectly: 6. Date of birth: Place of birth: SSN: Sex:  Male  Female Race: Color of hair: color of eyes: 7.  U.S. Citizen  Legal Permanent Resident  Qualified Alien or Non-Immigrant Requirements: Affidavit for Issuance of a Public Benefit and a Secure & Verifiable Document E-Verify Private Employer Affidavit of Compliance or E-Verify Private Employer Exemption Affidavit ---PAGE BREAK--- Statement of Personal History Form #4 Revised 7.08.24 2 I Page 8.  Single  Married  Widowed  Divorced  Separated If married or separated, complete information listed below: Full name of spouse: SSN# Maiden name: Place of birth: Date of birth: Name and address of spouse's employer: 9. State any other names that you have used: maiden name, names by former marriages, former names changed legally or otherwise, aliases, nicknames, etc. Specify which, show dates, etc.: 10. Employment record for the past ten (10) years. (list the most recent experience first). From To Occupation & Salary Employer Reason for Mo/Yr. Mo/Yr. Duties Performed Received (Business Name) Leaving 11. List all of your residences for the past ten (10) years, starting with the most recent: From To Street City State 12. Do you have any financial interest, or are you employed in any other wholesale or retail business engaged in distilling, bottling, rectifying, or selling alcoholic beverages? If your answer is "yes" to number 14, give names, locations, and amount of interest in each: 13. Have you ever had any financial interest in an alcoholic beverage business that was denied a license? If so, give details: ---PAGE BREAK--- Statement of Personal History Form #4 Revised 7.08.24 3 I Page 14. Has any alcoholic beverage license in which you hold, or have held, any financial interest of, or employed, or have been employed, ever been cited for any violations of the rules and regulations of the state revenue commissioner relating to the sale and distribution of alcoholic beverages? If so, give details: 15. If during the past ten years you have bought or sold any business associated with alcohol, give details. (date, license number, persons, and considerations involved): 16. Have you ever been denied bond by a commercial security company? If so, give details: 17. Are you a registered voter? In what state? 18. Have you ever been arrested, or held by federal, state or other law enforcement authorities, for any violation of any federal law, state law, county or municipal law, regulation or ordinances? (Do not include traffic violations. All other charges must be included even if they were dismissed. Give reason charged or held, date, place where charged and disposition. If no arrest, write no arrest. After last arrest is listed, please write no other arrest): 1. 2. 3. 4. ---PAGE BREAK--- Statement of Personal History Form #4 Revised 7.08.24 4 I Page 19. List below four references (personal and business). Give complete address and phone number including area code. If giving a business reference, name a person at the location to be contacted. Do not include relatives or employers or fellow employees of particular business. 1. 2. 3. 4. 20. Have you had any license under the regulatory powers of Dawson County denied, suspended, or revoked within two years prior to the filing of this application? If so, give details: 21. Copy of photo ID of applicant attached? 22. Attach photograph (front view) taken within the past year: (ATTACH PHOTO HERE) ---PAGE BREAK--- Statement of Personal History Form #4 Revised 7.08.24 5 I Page NOTE: Before signing this statement, check all answers and explanations to see that you have answered all questions fully and correctly. This statement is to be executed under oath and subject to the penalties of false swearing, and it includes all attached sheets submitted herewith. STATE OF GEORGIA, DAWSON COUNTY. I, , DO SOLEMNLY SWEAR, SUBJECT TO THE PENALTIES OF FALSE SWEARING, THAT THE STATEMENT AND ANSWERS MADE BY ME AS THE APPLICANT IN THE FOREGOING PERSONAL STATEMENT ARE TRUE AND CORRECT. FURTHER, AS PART OF THE PROCESS RESULTING FROM MY APPLICATION FOR BACKGROUND INVESTIGATION, FOR AN ALCOHOLIC BEVERAGE LICENSE. I HEREBY AUTHORIZE PERSONNEL OF THE DAWSON COUNTY SHERIFF'S DEPARTMENT OR DAWSON COUNTY ALCOHOL LICENSING OFFICE TO RECEIVE, VERIFY, AND DISSEMINATE ANY CRIMINAL HISTORY INFORMATION WHICH MAY BE IN THE FILES OF ANY LOCAL, STATE, OR FEDERAL CRIMINAL JUSTICE AGENCY FOR INVESTIGATIVE PURPOSES, DENIAL, OR APPEALS. APPLICANT'S SIGNATURE I HEREBY CERTIFY THAT SIGNED HIS/HER NAME TO THE FOREGOING APPLICATION STATING TO ME THAT HE/SHE KNEW AND UNDERSTOOD ALL STATEMENTS AND ANSWERS MADE THEREIN, AND UNDER OATH ACTUALLY ADMINISTERED BY ME, HAS SWORN THAT SAID STATEMENTS AND ANSWERS ARE TRUE AND CORRECT. THIS, THE DAY OF . 20 NOTARY PUBLIC ---PAGE BREAK--- This affidavit is a State of Georgia requirement that must be completed for initial applications and renewal applications for public benefits as referenced in O.C.G.A § 50-36-1(a)(3). The person who has made application for access to public benefits on behalf of an individual, business, corporation, partnership or other private entity must complete and sign the affidavit and provide a secure and verifiable document. Form #4-A 7-11-24 Page 1 of 2 Dawson County, Georgia Board of Commissioners Affidavit for Issuance of a Public Benefit As Required by the Georgia Illegal Immigration Reform and Enforcement Act of 2011 By executing this affidavit under oath, as an applicant for a Dawson County Business License, Out of County Business Registration, Alcohol License, or other public benefit as referenced in the Georgia Illegal Immigration Reform and Enforcement Act of 2011 [O.C.G.A. § 50-36-1(e)(2)], I am stating the following with respect to my application for such Dawson County public benefit. I am a United States citizen. I am a legal permanent resident of the United States. (FOR NON-CITIZENS) I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. (FOR NON-CITIZENS) My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 50-36-1(e)(1), with this affidavit. (See reverse side of this affidavit for a list of secure and verifiable documents.) The secure and verifiable document provided with this affidavit can best be classified as: In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20 and face criminal penalties as allowed by such criminal statute. Executed in (city), (state) Signature of Applicant Date Printed Name Name of Business SUBSCRIBED AND SWORN BEFORE ME ON THIS DAY OF Notary Public My Commission Expires: ---PAGE BREAK--- Form #4-A 7-11-24 Page 2 of 2 Secure and Verifiable Documents Under O.C.G.A. § 50-36-2 The following list of secure and verifiable documents, published under the authority of O.C.G.A. § 50-36-2, contains documents that are verifiable for identification purposes, and documents on this list may not necessarily be indicative of residency or immigration status. • A United States Passport or Passport Card [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2] • A United States Military Identification card [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2] • A Driver’s License issued by one of the United States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the Commonwealth of the Northern Marianas Islands, the United States Virgin Island, American Samoa, or the Swain Islands, provided that it contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2] • An Identification Card issued by one of the United States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the Commonwealth of the Northern Marianas Islands, the United States Virgin Island, American Samoa, or the Swain Islands, provided that it contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2] • A Tribal Identification Card of a federally recognized Native American tribe, provided that it contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer. A listing of federally recognized Native American tribes may be found at: http://www.bia.gov/WhoWeAre/BIA/OIS/TribalGovernmentServices/TribalDirectory/index.htm [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2] • A United States Permanent Resident Card or Alien Registration Receipt Card [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2] • An Employment Authorization Document that contains a photograph of the bearer [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2] • A Passport Issued by a Foreign Government [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2] • A Merchant Mariner Document or Merchant Mariner Credential issued by the United States Coast Guard [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2] • A Free and Secure Trade (FAST) card [O.C.G.A. § 50-36-2(b)(3); 22 CFR § 41.2] • A NEXUS Card [O.C.G.A. § 50-36-2(b)(3); 22 CFR § 41.2] • A Secure Electronic Network for Travelers Rapid Inspection (SENTRI) card [O.C.G.A. § 50-36-2(b)(3); 22 CFR § 41.2] • A Driver’s License issued by a Canadian Government Authority [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2] • A Certificate of Citizenship issued by the United States Department of Citizenship and Immigration Services (USCIS) (Form N-560 or Form N-561) [O.C.G.A. § 50-36-2(b)(3); 6 CFR § 37.11] • A Certificate of Naturalization issued by the United States Department of Citizenship and Immigration Services USCIS) (Form N-550 or Form N-570) [O.C.G.A. § 50-36-2(b)(3); 6 CFR § 37.11] ---PAGE BREAK--- Dawson County, Georgia Board of Commissioners Private Employer Affidavit of Compliance Pursuant to O.C.G.A. § 36-60- 6(d) By executing this affidavit, the undersigned private employer verifies its compliance with O.C.G.A. § 36-60- 6, stating affirmatively that the individual, firm or corporation employs more than ten employees and has registered with and utilizes the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-90. Furthermore, the undersigned private employer hereby attests that its federal work authorization user identification number and date of authorization are as follows: Federal Work Authorization User Identification Number E-Verify Number Date of Authorization Name of Private Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on , , 20 _in (city), (state). Signature of Authorized Officer or Agent Printed Name and Title of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON DAY OF , 20 NOTARY MY COMMISSION EXPIRES: Form #4-B 7-11-24 ---PAGE BREAK--- Dawson County, Georgia Board of Commissioners Private Employer Exemption Affidavit Pursuant to O.C.G.A. § 36-60-6(d) By executing this affidavit, the undersigned private employer verifies that it is exempt from compliance with O.C.G.A. § 36-60-6, stating affirmatively that the individual, firm or corporation employs fewer than eleven employees and therefore, is not required to register with and/or utilize the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable revisions and deadlines established in O.C.G.A. § 13-10-90. Signature of Exempt Private Employer Printed Name of Exempt Private Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on _ , , 20 in (city), (state). Signature of Authorized Officer or Agent Printed Name and Title of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF ,20 . NOTARY PUBLIC My Commission Expires: Form # 4-C 7-11-24 Page 1 of 1 ---PAGE BREAK--- Form #5 Revised 7.08.24 1 I Page Dawson County Alcohol Licensing 25 Justice Way, Suite 2223 I [PHONE REDACTED] Distilled Spirits Projected Purchases and Projected Gross Sales Applicant: Business Name: Address: Please provide the following projections for your establishment: Projected Purchases of Gross Distilled Spirits (in liters) Projected Gross Sales of Mixed Drinks Balance of Calendar Year Calendar Year ---PAGE BREAK--- DAWSON COUNTY SHERIFF'S OFFICE SHERIFF JEFF JOHNSON 19 Tucker Avenue Dawsonville, Georgia 30534 Office (706) 344-3535 - Fax (706) 344-3537 CRIMINAL HISTORY REQUEST I hereby request for the Dawson County Sherifrs Office to retrieve any criminal history record information, which may pertain to myself (or the person named below), that may be found in any state or local criminal justice agency in Georgia. Records obtained from the Dawson County Sheriffs Office shall only be used by the requesting agency or individual solely for the purposes requested. If any information is used to deny employment or license, it shall not reflect on the liability of this office, but on the agency or entity who makes that decision and to allow the person/applicant a chance to dispute any information which may be in error. Any dissemination of the information provided must be with permission of the person/applicant. Dawson County shall not be held responsible for information obtained by another agency, state or federal, which provides such information and whose files reflect records which may contain errors or omissions. TO ENSURE ACCURACY, PLEASE PRINT AND PROVIDE COMPLETE INFORMATION. Date of request: Authorization good for: D 7 D 30 D 60 D 90 D 180 days Agency requesting criminal history (name and phone#): Full name: Phone#: Address: SSN: Providing your SSN is voluntary. SSN helps confirm your identity and history. DOB: Sex: Race: Eyes: State of birth: Height: Weight: Hair : lndividual(s) authorized to receive criminal history: Any authorized individual(s) must present a valid identification upon receipt of this criminal history. f f a valid identification cannot be presented, the criminal history will not be released. Special employment provisions (check if applicable): D Employment with mentally disabled (Purpose code 0 Employment with elder care (Purpose code D Employment with children (Purpose code To be completed by Dawson County Sheriff's Office personnel: Select purpose code used: D C D E D F D J D M D N D P D U D W DZ Case number or criminal history number used: _ Date of inquiry: Time of inquiry: Operator's initials: SIGNATURE OF APPLICANT SIGNATURE OF RECEIVING PERSON NOTARY SIGNATURE NOT ARY ST AMP x Massey Dawson County Alcohol Licensing, [PHONE REDACTED] ---PAGE BREAK--- See Page 2 for Spanish translation. 1 Updated 11/6/2019 NONCRIMINAL JUSTICE APPLICANT’S PRIVACY RIGHTS As an applicant who is the subject of a national fingerprint-based criminal history record check for a noncriminal justice purpose (such as an application for employment or a license, an immigration or naturalization matter, security clearance, or adoption), you have certain rights which are discussed below. All notices must be provided to you in writing. 1 These obligations are pursuant to the Privacy Act of 1974, Title 5, United States Code Section 552a, and Title 28 Code of Federal Regulations (CFR), 50.12, among other authorities. • You must be provided an adequate written FBI Privacy Act Statement (dated 2013 or later) when you submit your fingerprints and associated personal information. This Privacy Act Statement must explain the authority for collecting your fingerprints and associated information and whether your fingerprints and associated information will be searched, shared, or retained. 2 • You must be advised in writing of the procedures for obtaining a change, correction, or update of your FBI criminal history record as set forth at 28 CFR 16.34. • You must be provided the opportunity to complete or challenge the accuracy of the information in your FBI criminal history record (if you have such a record). • If you have a criminal history record, you should be afforded a reasonable amount of time to correct or complete the record (or decline to do so) before the officials deny you the employment, license, or other benefit based on information in the FBI criminal history record. • If agency policy permits, the officials may provide you with a copy of your FBI criminal history record for review and possible challenge. If agency policy does not permit it to provide you a copy of the record, you may obtain a copy of the record by submitting fingerprints and a fee to the FBI. Information regarding this process may be obtained at and • If you decide to challenge the accuracy or completeness of your FBI criminal history record, you should send your challenge to the agency that contributed the questioned information to the FBI. Alternatively, you may send your challenge directly to the FBI by submitting a request via The FBI will then forward your challenge to the agency that contributed the questioned information and request the agency to verify or correct the challenged entry. Upon receipt of an official communication from that agency, the FBI will make any necessary changes/corrections to your record in accordance with the information supplied by that agency. (See 28 CFR 16.30 through 16.34.) • You have the right to expect that officials receiving the results of the criminal history record check will use it only for authorized purposes and will not retain or disseminate it in violation of federal statute, regulation or executive order, or rule, procedure or standard established by the National Crime Prevention and Privacy Compact Council.3 1 Written notification includes electronic notification, but excludes oral notification. 2 3 See 5 U.S.C. 552a(b); 28 U.S.C. 534(b); 34 U.S.C. § 40316 (formerly cited as 42 U.S.C. § 14616), Article IV(c); 28 CFR 20.21(c), 20.33(d) and 906.2(d). ---PAGE BREAK--- 2 Actualizado 6/11/2019 DERECHOS DE PRIVACIDAD DE SOLICITANTES - JUSTICIA, NO CRIMINAL Como solicitante sujeto a una indagación nacional de antecedentes criminales basado en huellas dactilares, para un propósito no criminal (tal como una solicitud para empleo o una licencia, un propósito de inmigración o naturalización, autorización de seguridad, o adopción), usted tiene ciertos derechos que se entablan a continuación. Toda notificación se le debe proveer por escrito.1 Estas obligaciones son de acuerdo al Privacy Act of 1974, Title 5, United States Code Section 552a, y Title 28 Code of Federal Regulations (CFR), 50.12, entre otras autorizaciones. • Se le debe proveer una Declaración de la Ley de Privacidad del FBI (con fecha de 2013 o más reciente) por escrito cuando presente sus huellas digitales e información personal relacionada. La Declaración de la Ley de Privacidad debe explicar la autorización para tomar sus huellas digitales e información relacionada y si se investigarán, compartirán, o retendrán sus huellas digitales e información relacionada.2 • Se le debe notificar por escrito el proceso para obtener un cambio, corrección, o actualización de su historial criminal del FBI según delineado en el 28 CFR 16.34. • Se le tiene que proveer una oportunidad de completar o disputar la exactitud de la información contenida en su historial criminal del FBI (si tiene dicho historial). • Si tiene un historial criminal, se le debe dar un tiempo razonable para corregir o completar el historial (o para rechazar hacerlo) antes de que los funcionarios le nieguen el empleo, licencia, u otro beneficio basado en la información contenida en su historial criminal del FBI. • Si lo permite la política de la agencia, el funcionario le podría otorgar una copia de su historial criminal del FBI para repasarlo y posiblemente cuestionarlo. Si la política de la agencia no permite que se le provea una copia del historial, usted puede obtener una copia del historial presentando sus huellas digitales y una tarifa al FBI. Puede obtener información referente a este proceso en summary-checks y • Si decide cuestionar la veracidad o totalidad de su historial criminal del FBI, deberá presentar sus preguntas a la agencia que contribuyó la información cuestionada al FBI. Alternativamente, puede enviar sus preguntas directamente al FBI presentando un petición por medio de El FBI luego enviará su petición a la agencia que contribuyó la información cuestionada, y solicitará que la agencia verifique o corrija la información cuestionada. Al recibir un comunicado oficial de esa agencia, el FBI hará cualquier cambio/corrección necesaria a su historial de acuerdo con la información proveída por la agencia. (Vea 28 CFR 16.30 al 16.34.) • Usted tiene el derecho de esperar que los funcionarios que reciban los resultados de la investigación de su historial criminal lo usarán para los propósitos autorizados y que no los retendrán o diseminarán en violación a los estatutos, normas u órdenes ejecutivos federales, o reglas, procedimientos o normas establecidas por el National Crime Prevention and Privacy Compact Council.3 1 La notificación por escrito incluye la notificación electrónica, pero excluye la notificación verbal. 2 3 Vea 5 U.S.C. 552a(b); 28 U.S.C. 534(b); 34 U.S.C. § 40316 (anteriormente citada como 42 U.S.C. § 14616), Article IV(c); 28 CFR 20.21(c), 20.33(d) y 906.2(d). ---PAGE BREAK--- DAWSON COUNTY ALCOHOL LICENSING 25 Justice Way I Suite 2223 I Dawsonville, GA 30534 I DawsonCountyGa.gov I (706) 531-2306 Date: To: Law Enforcement 19 Tucker Avenue Dawsonville, GA 30534 From: Alcohol Licensing Administrator 25 Justice Way, Suite 2223 Dawsonville, GA 30534 Re: Application for Alcoholic Beverage The Following applicant is applying for an Alcoholic Beverage License and must be fingerprinted as part of the Background Check. Dawson County ORI: GA923216Z Applicant: Business Name: The applicant has paid an Administrative/Investigative Fee that covers the cost of fingerprinting. Please process and return the report to Massey Please call Dawson County Alcohol Licensing at [PHONE REDACTED] with any questions. Fingerprint Procedure