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Alcoholic Beverage License Application Check List Business Name: Application submitted on Sworn Statement of Eligibility Sworn Statement of No Change to Premise Facility Plans and Survey of Premise Copy of application for State of Georgia License Georgia Security and Immigration Compliance Act – Applicant Benefit Affidavit Copy of Georgia Drivers License or other Verifiable ID Finger Prints and Back Ground Check Inspection of Premise Cash Bond or Insurance Bond License Fee Approval Date of BOC MORGAN COUNTY PLANNING AND DEVELOPMENT 150 East Washington Street, Suite 200 P.O. Box 1357 Madison, Georgia 30650 (706)342-4373 Office · (706)343-6455 Fax ---PAGE BREAK--- Over Instructions for Applying for an Alcoholic Beverage License 1. You must read, understand and comply with all provisions of Chapter 6 - Alcoholic Beverages of the Morgan County Code of Ordinances, adopted May 1, 2007 and as amended. 2. You must get fingerprinting done at the Sheriff’s office, located at 1380 Monticello Highway, Madison, Georgia 30650. To do this you must call (706) 342-1507 to make an appointment. All appointments must be made seven in advance. At the time fingerprinting is done you will need to bring the following: a. $5.00 cash only b. $37.25 for County printing fee. money order only payable to Morgan County Sheriff’s office for processing fingerprints. 3. You must complete and sign an Individual Criminal History Consent Form at the Sheriff’s office. 4. Please complete the Application for the Sale of Alcoholic Beverages. The Sworn Statement of Eligibility and Georgia Security and Immigration Compliance Act Benefit Affidavit, must be sign and notarized. Incomplete applications will not be accepted . Return the application and forms in person to the Morgan County Planning & Development Office no later than November 8, 2012. No applications will be placed on the November work session that is received after November 8, 2012. Applications received after November 8, 2012 will be placed on the December work session and will be voted on at the regular January meeting. 5. You must include with the application packet the following information: a. A copy of the submitted State of Georgia Alcohol License application with all attachments. b. A scaled drawing of the location of the proposed premises showing the distance to the nearest church, school and alcohol rehabilitation center and a certificate from a registered surveyor stating that such location complies with the Morgan County Ordinance. (If the drawing has been submitted previously, then a sworn affidavit must be submitted that there is no change.) c. Detailed plans for the building and outside premises in which the business will be located. (If the drawing has been submitted previously, then a sworn affidavit must be submitted that there is no change.) MORGAN COUNTY PLANNING AND DEVELOPMENT 150 East Washington Street, Suite 200 P.O. Box 1357 Madison, Georgia 30650 (706)342-4373 Office · (706)343-6455 Fax ---PAGE BREAK--- d. A copy of your driver’s license or any other form of photo identification to confirm that you are at least 25 years of age. 6. You must schedule an inspection of the establishment by the Planning & Development office for compliance with the ordinance prior to submitting the application for the license. 7. If this is the first time you are applying for an Alcoholic Beverage license in Morgan County, contact your district Commissioner for your district. Inform him/her of your plans so it can be discussed at the next Commissioner’s meeting. 8. The applications will be reviewed at the Commissioner’s work session in November and will be voted on at their regular meeting on December 4, 2012. You will be notified of the decision. If your application is approved, you may bring your cash bond or performance bond along with the required fee to the Planning & Development office and pick up your license. If your application is rejected, you will be notified of the cause of rejection. 9. A cash bond or performance bond of $500.00 for package sale license, a bond of $1000.00 for a pouring license and a bond of $2500.00 for a wholesale license is required. Bond shall be payable to Morgan County Board of Commissioners. 10. The fee for an Alcoholic Beverage license is $500.00 per year for package sales and $1000.00 per year for a pouring license. Please contact the Planning & Development office for wholesale license fees. Only cash, money orders, or certified checks will be accepted. All fees are to be payable to Morgan County. Licenses must be renewed each year by January 1st in order to continue to sell alcoholic beverages in Morgan County ---PAGE BREAK--- Page 1 of 3 Application for the Sale of Alcoholic Beverages Applicant Information Owner’s Name: Social Security Number: (If the Owner is a Corporation or a multiple partner ownership, then provide information on each individual and attach to this application) Physical Address: City: State: Zip Code: Mailing Address: City: State: Zip Code: Daytime Phone: Evening Phone: Date of Birth: Current Age: Establishment Information Retail Business Wholesale Business Catering Business Restaurant Establishment Name: Physical Address: City: State: Zip Code: Mailing Address: City: State: Zip Code: Phone Number: Number of Employees: Days of Operation: Hours of Operation: Type of License Package Sale of Malt Beverages and Wine Wholesale of Malt Beverages and Wine Sale of Malt Beverages and Wine for Consumption on the Premises Alcoholic Beverage Catering MORGAN COUNTY PLANNING AND DEVELOPMENT 150 East Washington Street, Suite 200 P.O. Box 1357 Madison, Georgia 30650 (706)342-4373 Office · (706)343-6455 Fax ---PAGE BREAK--- Page 2 of 3 Owner’s Agent or Manager Information Owner’s Agent or Manager’s Name: Physical Address: City: State: Zip Code: Mailing Address: City: State: Zip Code: Daytime Phone: Evening Phone: Date of Birth: Current Age: Social Security Number: Employee Information Employee Name: Social Security Number: Physical Address: City: State: Zip Code: Mailing Address: City: State: Zip Code: Daytime Phone: Evening Phone: Date of Birth: Current Age: Employee Name: Social Security Number: Physical Address: City: State: Zip Code: Mailing Address: City: State: Zip Code: Daytime Phone: Evening Phone: ---PAGE BREAK--- Page 3 of 3 Date of Birth: Current Age: Employee Name: Social Security Number: Physical Address: City: State: Zip Code: Mailing Address: City: State: Zip Code: Daytime Phone: Evening Phone: Date of Birth: Current Age: Employee Name: Social Security Number: Physical Address: City: State: Zip Code: Mailing Address: City: State: Zip Code: Daytime Phone: Evening Phone: Date of Birth: Current Age: Employee Name: Social Security Number: Physical Address: City: State: Zip Code: Mailing Address: City: State: Zip Code: Daytime Phone: Evening Phone: Date of Birth: Current Age: ---PAGE BREAK--- Alcoholic Beverage Sworn Affidavit of No Changes to Premise I, certify that no changes or additions to the building or grounds of have occurred since the original diagram of building was submitted to the Morgan County Board of Commissioners. The diagram of building is on file with Morgan County. I also certify that no changes have occurred regarding distances to Churches, Schools or Rehabilitation Centers. A diagram conducted by a registered surveyor is on file with the Morgan County Board of Commissioners. Owner’s Signature Date Sworn to and Subscribed before me This day of Notary Signature MORGAN COUNTY PLANNING AND DEVELOPMENT 150 East Washington Street, Suite 200 P.O. Box 1357 Madison, Georgia 30650 (706)342-4373 Office · (706)343-6455 Fax ---PAGE BREAK--- Georgia Security and Immigration Compliance Act Applicant Benefit Affidavit Applicant: Name of Establishment: Establishment Address: By executing this affidavit under oath, as an applicant for an Alcoholic Beverage License, as referenced in O.C.G.A. § 50-36-1, from the Morgan County Board of Commissioners, the undersigned applicant verifies one of the following with respect to my application for a public benefit: I am a United States citizen. I am a legal permanent resident of the United States. 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. 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. 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. This document was executed in Madison, Georgia. Signature of Applicant Printed Name of Applicant SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF NOTARY PUBLIC My Commission Expires: Official Use Only The secure and verifiable document provided with this affidavit can best be classified as: U.S. Passport U.S. Passport Card U.S Military ID U.S Driver’s License* Tribal ID Card U.S. Permanent Resident Card Alien Registration Card Foreign Gov. Passport Employment Authorization Card Merchant Mariner Card Free & Secure Trade Card Nexus Card SENTRI Card Canadian Driver’s License Certificate of Citizenship Certificate of Naturalization Matricula Consular ID Copy of Document Attached *Note: A driver’s license from Alaska, Idaho, Illinois, New Jersey, New Mexico, New York, Rhode Island, Utah and Washington is not a verifiable document. Maryland and Massachusetts are pending. Verified By: Date: ---PAGE BREAK--- Over Sworn Statement of Eligibility for the Sale of Alcoholic Beverages I, being a person of good moral character, do hereby make application for a license to engage in the package sale of malt beverages and wine in Morgan County, Georgia, at: Establishment Name: Address: City: State: Zip Code: Phone Number: Licensee Qualifications and Acknowledgements Section 6-52. - I am over the age of 25 and have been a resident of the State of Georgia for a minimum of one year. Section 6-54. – I am not an official or employee of the county, nor a member of the Board of Commissioners. Section 6-55. - I have not been convicted nor pled nolo contendre within the previous ten (10) years of the date of this application to a felony or a misdemeanor involving moral turpitude. Furthermore, I have not been convicted under federal, state or local law for a criminal offense involving alcoholic beverages, gambling or tax law violations. Section 6-56. - I have not been denied a license to sell alcoholic beverages within one year of the date of this application. Section 6-57. – I am the owner(s) or authorized agent of the parent corporation of the premises for which the license is requested or the holder of any lease thereon. Section 6-58. – I attest that I, or the corporation, have adequate financial participation in the proposed business to direct and mange its affairs. Section 6-198. – I understand that I am responsible for the management and operation of the business for which the license is granted and shall be responsible for all violations by the licensee’s agents and employees. Section 6-300 - I understand that any violation of federal, state, or any of the regulations adopted by Morgan County pertaining to the sale of malt beverages and wine, shall subject my license to immediate revocation or suspension. Section 6-210 - I have in possession a copy of the Morgan County Alcoholic Beverage Ordinance and I have read and understand the regulations. Section 6-324 – I understand that I must post a cash bond or a performance bond with the Morgan County Board of Commissioners in the amount of $500.00 for retail establishments and $2,500.00 for wholesale establishments. MORGAN COUNTY PLANNING AND DEVELOPMENT 150 East Washington Street, Suite 200 P.O. Box 1357 Madison, Georgia 30650 (706)342-4373 Office · (706)343-6455 Fax ---PAGE BREAK--- Section 6-325 – I understand that the annual license fee is $500.00 and must be paid prior to issuance of a license. The license is only valid for the year in which it is issued and shall expire on December 31 of the year that it is granted. Section 6-328 – I understand that the annual license fee stated in this section must be paid prior to issuance of a license. The license is only valid for the year in which it is issued and shall expire on December 31 of the year that it is granted. Section 6-354 – I understand that I must post a cash bond or a performance bond with the Morgan County Board of Commissioners in the amount of $1000.00 for a pouring license. Section 6-358 – I understand that the annual license fee is $1000.00 and must be paid prior to issuance of a license. The license is only valid for the year in which it is issued and shall expire on December 31 of the year that it is granted. Section 6-391 – I understand that the annual license fee is $100.00 per location and must be paid prior to issuance of a alcoholic catering license. The license is only valid for the year in which it is issued and shall expire on December 31 of the year that it is granted. Section 6-142. – I understand that any misstatement, false statement, or concealment of fact in this application shall be grounds for the denial of the application for license issuance or revocation of the license issued, and shall make the applicant liable to prosecution for perjury under the laws of the state. I have read and I understand the Alcoholic Beverage regulations and the qualifications and acknowledgements above and agree to abide by these regulations. I certify to the best of my knowledge that all items of the application and sworn statement are true and correct. Signed: Sworn to and subscribed before me This day of 20 If ownership is vested in more than one person, additional owners Sign Below: (Signature) Notary Public Please Note: Please return all required documents in person to the Morgan County Planning & Development Office no later than November 8, 2012. The applications will be reviewed at the Commissioner’s work session in November and will be voted on at their regular meeting on December 4, 2012. No application will be placed on the November work session that is received after November 8, 2012. Applications received after November 8, 2012 will be placed on the December work session and will not be voted on until the regular meeting in January. You will be notified of the decision. If your application is approved, you may bring your performance bond and required fee to the Planning & Development office and pick up your license. If your application is rejected, you will be notified of the cause of rejection. THIS SPACE IS FOR COMMISSIONERS USE ONLY APPROVED DATE: DISAPPROVED Clerk, Morgan County Commissioners (Form Revised 10-20-10)