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Person applying for this license First Name M.I. Last Name Suffix DOB Phone Residence address, including city Email Business Name dba, if applicable Business phone Mailing address for license, if different Annual Liquor License issued by McLean County Other County, specify: Town, City, Village, specify: State of Illinois License # Description of the event/function: Name of event, if applicable Type of event Location Number of days, if a multi-day event Date(s) to be held Rain date? Hours Type of Liquor Service (check all applicable boxes) Canned and bottled beer and cocktails Wine Kegs Mixed Drinks Slushies Other, specify: Will ice be served? Yes No Application for a McLean County Class F Retailer's License Relationship to business of person applying Address of licenced premises ---PAGE BREAK--- Attach the following documents: Certificate of Insurance issued in compliance with Paragraph E of Section 160-19 of the McLean County Code Copy of the Liquor License that you hold from the municipality or county. Deliver Checks for proper fees payable to McLean County Clerk: Clerk's Fee ($16) plus License Fee of $100/day. Apply for State of Illinois Liquor License(s). See Applicant Statement #5 below. Applicant Statements 1) Applicant hereby states that there is no provision of the law of the State of Illinois disqualifying applicant from receiving this license. 2) Applicant is completely familiar with the terms and provisions of Chapter 160 "Alcoholic Beverages" and Chapter 216 "Food Service" of the McLean County Code. 3) Applicant has not been cited for any violations of liquor control ordinances in McLean County or the issuing city, town or village within the past twelve months preceding the application. 4) There will be no fee charged for admittance to the function. 5) Applicant hereby states that s/he will apply to the Illinois Liquor Control Commission for a Special Event permit/license immediately after receiving the McLean County liquor license, and if denied or otherwise unable to obtain a state license, the applicant will immediately notify the McLean County Liquor Control Commissioner. I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. By selecting "I agree," I am signing and affirming all content in this application is true to the best of my knowledge and belief. Applicant Signature SIGN