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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]