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Application for Beer/Alcohol License Ogden City Customer Service Center 2549 Washington Blvd. Suite 240 Ogden, UT 84401 Phone: [PHONE REDACTED] Business License # State Sales Tax # Drivers license # New Business New Owner New Location Corporation Limited Liability Company Limited Liability Partnership Partnership Individual/ Sole Proprietorship Other: Print Name of applicant: (Legal Name of individual or entity to who the license is intended to be issued.) Business name or DBA, if different from the name of the Applicant: Business Location City State Zip Business Phone Contact # Mailing Address City State Zip E-mail If applicant is an individual: date of birth Number of employees in this business Opening date of business Description of business Corporate agent for the business Mailing Address City State Zip Name of property owner, if different than applicant Mailing Address City State Zip This is an application for a business license; the actual license will be issued only when ALL inspections are received and approved. All information must be accurately completed or the issuance of the license will be delayed. Issuance of this business license shall in no way relieve the applicant of his/her responsibility of complying with applicable zoning, health, building, or fire regulations. I, we hereby apply for a Class beer/alcohol license to vend beer/alcohol at the above premise in Ogden City. 1. The applicant’s name in full. If the applicant is a partnership, the applicant shall state the name and address of all copartners and if a corporation, the names and addresses of its principal officers and directors and the name of the manager of the premises to be licenses Name Residential Address City/ST Zip interest in business DOB 2a. Is the applicant, and each of the persons name in paragraph 1 hereof, a person over the age of 21 years? Yes No if no, explain. License Fees: Base license fee $ Disproportionate fee $ Special reg. fee $ Employee fee $ Other fee $ Total fees $ Penalty $ Total due $ ---PAGE BREAK--- 2b. Has the applicant, or any of the persons name in Paragraph 1 hereof, ever been convicted of a felony or or any misdemeanor other than minor traffic offenses (including military) or are there any chargers pending against the applicant or any person named herein? Yes No if yes, explain. 2c. Attached a current copy or copies of Bureau of Criminal Identifications background check (BCI’s) for owners and managers. (Class A Beer requires Nation Wide or FBI background check) Yes No 3. Names of all the owners of the building where business is to operate. Name Residential Address City State Zip Phone 4. What interest (lease, option, own, etc.) in the building where business to be operated does the applicant have? 5. Name and addresses of all employees (managers must also meet the same requirement as the applicant) : Name Residential Address City State Zip Phone 6. How close to a public or private school, church, public library, public playground, or park for which this license is sought? 7. Are there more than two taverns in the same block, including both sides of the street at this premise? If so, has a grandfather privilege been maintained? 8. Has any brewer, wholesaler of beer or dealer in beer,/alcohol directly or indirectly, supplied, given, or paid for, or hereafter supply, give or pay for any furniture, furnishings, or fixtures used or to be used in vending beer/alcohol; loaned or promised to loan any money for the commencement or conduct of business vending beer/alcohol; now either directly or indirectly financially interested in, or will such brewer, wholesaler or dealer become directly financially interested in the conduct or operation of the business or retail vending of beer/alcohol license for which is applied for in this application? Yes No ifs yes, explain. 9. If this beer license is to be issued to a public restaurant license, will no less than 51 percent of its total restaurant for the sale of food? Yes No 10. If this beer license is to be issued to a public restaurant license, will no less than 71 percent of its total restaurant for the sale of food? Yes No The undersigned, either as an individual, or as the authorized representative of the Applicant, hereby agree to conduct said business strictly in accordance with the Laws and Ordinances covering such business, and understand that it is unlawful to make any false statement, declaration, or report as required in this application. Date Signed by Name/Title: Official Use Only: Zone Census Track Traffic Planning Community Planning Approved Not approved By: Date Department Approved Not approved By: Date License Officer Approved Not approved By: Date