Document Unioncountyga_doc_be7bf72c01

2025 ALCOHOL LICENSE APPLICATION Dear Applicant, A fully completed packet must be received by the Commissioner’s Office at least 16 days prior to the next Alcohol Board meeting in order for the application to be heard by the Board. This timeframe is required to allow time for all background check results to arrive. If the packet is not received within this time frame, the application will be heard at the next scheduled Alcohol Board meeting. 2025 Alcohol Board Meetings January 7 ~ February 4 ~ March 4 ~ April 1 May 6 ~ June 3 ~ July 1 ~ August 5 ~ September 2 ~ October 7 ~ November 4 ~ December 2 (Meetings are subject to change. If an Alcohol Board Meeting date changes, information will be posted on the Union County Government website. Residents may also call the Commissioner’s Office for additional information: [PHONE REDACTED].) The attached list is provided as a courtesy to help applicants navigate the process of applying for an Alcohol License in Union County. If you have not read the Union County Alcohol Ordinance, please download it from this location: COOR_CH10AMEN_ARTIIIALBE ---PAGE BREAK--- Page 1 2/11/2025 ALCOHOL LICENSING REQUIRED DOCUMENTATION Union County, Georgia A complete Alcohol Application must be received at least 16 days prior to the next Alcohol Board Meeting so that the background check results are received in time for the meeting. The following must be received before the Alcohol Board will consider Application for approval: Completed Application (Form 1) Fill out the Application fully, legibly and completely. The Applicant must be the owner of the business unless the business is a corporation or LLC with more than 50 employees. The Applicant must be at least 21 years of age. Government issued Photo ID of Applicant Required License fees (see Fee Schedule) Must be paid with check, money order, or cash remitted to the Union County Commissioner’s Office. See current Fee Schedule for correct license fee amount. If there are questions about the total amount owed, please call [PHONE REDACTED] and ask for Renee Deibert. Administrative fees ($250.00 per license applied for) Must be paid with check, money order, or cash remitted to the Union County Commissioner’s Office. See current Fee Schedule for correct license fee amount. If there are questions about the total amount owed, please call [PHONE REDACTED] and ask for Renee Deibert. Additional Information regarding license and administrative fees: • If applicant is denied a state license, the deposit representing the initial license fee(s) shall be refunded, but the cost paid for the application, investigation and administrative cost shall be retained by the County. • Any applicant for a license who has in existence at the time of making the new application an existing license shall pay a standard administrative fee of one-half the regular administrative fee but shall pay a separate full license fee for each license. • When an applicant is making applications for more than one license at the same time, the applicant shall pay only one administrative fee of 125% of a normal administrative fee but shall pay a separate full license fee for each license. • The payment of all license fees in full shall be a prerequisite to the issuance of a license unless otherwise provided by resolution of the governing authority. • The suspension or revocation of any license granted shall not entitle the licensee to a return of any portion of the license fees. Updated December 9, 2024 ---PAGE BREAK--- Page 2 2/11/2025 SAVE Affidavit (Form Systematic Alien Verification for Entitlements is an Affidavit for a Public Benefit as required by the Georgia Security and Immigration Compliance Act. Please sign and have notarized. Background Check Consent (Forms 3a – 3c.) Complete this form with the Applicant’s information and return to the Union County Commissioner’s Office. Payment will be required of $72.50 at this time and the form will be given back to you with a paid receipt. Take this form along with $10.00 to the Sheriff’s Office for fingerprinting, which will search the file of the crime information center for any instance of criminal activity during the three years immediately preceding the date of the application. The results of the Background Check will be delivered by the Sheriff’s Office to the Union County Commissioner’s Office. Registered Agent Consent (Form All applications must name a Registered Agent who shall be a resident of Union County. Residency shall be proven by two of the following three documents: a current utility bill, a current voter registration card, or a valid driver’s license. Government issued Photo ID of Registered Agent Additional Proof of Residency Applicant Affidavit Regarding Training (Form Complete this form affirming that you, as the applicant, will require all employees of the licensed establishment to complete one of the online training courses on the regulations governing the sale of alcoholic beverages. A list of training options can be found at: beverage-delivery-training-providers Copy of Policies and Procedures for the Sale of Alcohol Provide a copy of your Company’s Rules/Regulations/Policies/Procedures instructing employees on how to handle alcoholic beverages. Evidence of ownership of building/Lease Provide proof of ownership of the premises by a Warranty Deed, a copy of closing statement if recently purchased, a copy of the Lease if the premises are leased, or a copy of the Franchise Agreement if the organization is a Franchise. Tax Delinquency Certification (Form DO NOT COMPLETE THIS FORM. This form is provided so you will be aware of what the Union County Tax Commissioner’s Office will require of you. The County Agent will certify that no taxes are due at the time of application. All property taxes and personal property taxes must be current, including taxes in the applicant’s name and taxes on the property where the business is located. ---PAGE BREAK--- Page 3 2/11/2025 Safety Compliance Checklist (Form DO NOT COMPLETE THIS FORM. This form is provided so you will be aware of what the Alcohol Enforcement Officer will be checking when they inspect your business prior to the sale of alcohol. For Corporations or LLC’s, attach Certificate or Articles of Incorporation, and for Partnerships attach Partnership Agreement Affidavit of Publication from North Georgia News The following advertisement must be published in the Legal Organ of the County for a period of two consecutive weeks. The advertisement shall be at least one eighth of a page and at least an 8-point font size. The newspaper will then issue an Affidavit of Publication, which must be included in the application. A sample notice is shown below. NOTICE In accordance with the Union County Alcohol Licensing Ordinance I, John Q. Public of Your Business name Business location address line 1 Business location address line 2 Phone number Hereby make application for the following license(s): (List only those you are applying for below: remove this line in ad) -Malt beverage for sale by the package -Wine for sale by the package -Malt beverages for consumption on the premises -Wine for consumption on the premises -Distilled spirits for consumption on the premises -Wine & Craft Beer by the package and ancillary wine and craft beer tasting -Farm Winery -Manufacturing of Malt Beverages -Manufacturing of Distilled Spirits Summary of initial costs: Admin Fee (for processing): $250.00 Fingerprinting (Cash Only): $10.00 Background Check: $72.50 License: (See Fee Schedule) Once all of the above documents and procedures are complete, call Renee Deibert at (706) 897-4598 to schedule a time to “review” the Application. Failure to “review” the application packet could result in a delayed approval process. ---PAGE BREAK--- UNION COUNTY ALCOHOL LICENSING 65 Courthouse Street Blairsville, GA 30512 Phone (706) 439-6000 ~ Fax (706) 439-6004 FORM – 1 APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE This application must be signed by the applicant. EVERY QUESTION MUST BE COMPLETELY ANSWERED. IF THE QUESTION DOES NOT PERTAIN, SO INDICATE. 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 submitted to the Union County Commissioner’s Office, together with the license fee(s) and the administrative fee. All fees are payable to the Union County Government in (cash, money order or check). The applicant must be at least 21 years of age. NOTICE: A false answer to any question could result in the denial of a license. In the event a license is issued, false answers could result in the revocation or suspension of the license. Name of Applicant: Name of Business: 1. LICENSE CATEGORY: Malt beverages for sale by the package over 20,000 sq. ft. under 20,000 sq. ft. Wine for sale by the package over 20,000 sq. ft. under 20,000 sq. ft. Malt beverages for consumption on the premises Wine for consumption on the premises Distilled spirits for consumption on the premises Wine & craft beer only by package, with growler sales, & with ancillary wine & craft beer tasting Farm winery Manufacturing Malt Beverages Manufacturing Distilled Spirits; fruits and/or agricultural products other than fruit. Wholesale FOR OFFICIAL USE ONLY: Date Received: License Fee Received: $ Date Approved: Date Denied: Local License Number: State License Number: Administrative Fee Received: $ ---PAGE BREAK--- Page 1 2/11/2025 2. TYPE OF BUSINESS: Restaurant Hotel/Motel Wine & Craft Beer Grocery Store Farm Winery Wholesaler Convenience Store Distillery Other * * Please explain 3. For distilled spirits sales: Is the place of business more than 100 yards from any church building or alcoholic treatment center and more than 200 yards of any school building, educational building, school grounds or college campus as measured by the most direct route of travel on the ground? Yes No N/A 4. For wine or malt beverage sales: Is the place of business more than 100 yards from any school building, school grounds, college campus or alcoholic treatment center? Yes No N/A 5. Business Name to which the License will be issued, if approved: Business Name: Business Location Address Business Mailing City State Zip Code 6. Individual Applicant in whose name the license will be issued: (Applicant must be at least 21 years of age, provide proof of U.S. Residency and be the owner of the business, unless exempt by having more than 50 employees, as stated in Section 10.83(b) of the Alcohol Ordinance) Individual Name Address City State Zip Code Phone E-Mail (Required) Is the Applicant at least twenty-one (21) years of age or older? Yes No Is the Applicant: (check one) A United States citizen? A legal permanent resident? A qualified alien or non-immigrant under the Federal Immigration and Nationality Act and lawfully present in the United States? ---PAGE BREAK--- Page 2 2/11/2025 7. Registered Agent: (Register Agent must be at least 21 years of age and provide proof of U.S. Residency. Registered Agent must also provide proof of Union County residency with two of the following three documents: a current utility bill in their name, a current voter registration card, or a valid driver’s license.) Name: Residence Address City State Zip Code Phone E-Mail Is the Registered Agent at least twenty-one (21) years of age or older? Yes No Is the Registered Agent: (check one) A United States citizen? A legal permanent resident? A qualified alien or non-immigrant under the Federal Immigration and Nationality Act and lawfully present in the United States? Is the Registered Agent a Union County Resident? Yes No (Note: If the registered agent changes, the licensee shall notify the County within 30 days of the change. A fee of $100 will be charged for the processing of an application for the change of the registered agent.) 8. Type of Ownership (Please mark appropriate box and fill out section a or b as indicated): Partnership Sole Proprietor Limited Liability Company Other (Please explain) Corporation For Partnership or LLC: Partnership or LLC Name: Address: Phone: City: State: Zip Code: Partners or LLC members having a 5% or greater interest shall list the names, addresses and ownership interest of each (If more than 2, please list on separate sheet.) : Full Legal Name % Interest Home Address Phone City State Zip Code Age Length of Residency Full Legal Name % Interest Home Address Phone City State Zip Code Age Length of Residency FIRST MEMBER SECOND MEMBER ---PAGE BREAK--- Page 3 2/11/2025 For Corporation: (Name must be shown exactly as in Articles of Incorporation or Charter) Name of Corporation Date of Incorporation Place of Incorporation Address Phone City State Zip Code Officers (If more than 2, attach additional sheet): Full Legal Name % Stock Owned Office Held Home Address Phone City State Zip Code Age Length of Residency Full Legal Name % Stock Owned Office Held Home Address Phone City State Zip Code Age Length of Residency Full Legal Name % Stock Owned Office Held Home Address Phone City State Zip Code Age Length of Residency Trustees or the designated fiduciary agent(s) for other types of legal entities: Full Legal Name % Stock Owned Office Held Home Address Phone City State Zip Code Age Length of Residency SECOND OFFICER THIRD OFFICER ---PAGE BREAK--- Page 4 2/11/2025 9. Property: Owner of the property (land and building) where the business will be located: (In addition, attach to the application evidence of ownership of the building or proposed building. If property is leased, must attach copy of lease or if a franchise, attach copy of franchise agreement or contract.) Property Owner Name Property Address City State Zip Code Is the space where the business is to be located rented or leased? Yes No If yes, please state name of landlord or lessor and address: Name Address City State Zip Code If the space is rented or leased, is the rent for the premises to be paid to the landlord or lessor on a percentage of the business or contingent upon the amount of business done? Yes No 10. Disclosure of previous denials: Is there any person, registered agent, or anyone holding a five percent interest or more in this business who has APPLIED AND BEEN DENIED for a beer, wine, and/or liquor license from Union County or other City or County in the State of Georgia or other state or political subdivision? Yes* No *If yes, please give full details on separate sheet. Is there any person, registered agent, or anyone holding a five percent interest or more in this business who has had an alcoholic beverage license REVOKED or suspended by or surrendered to any federal, state or local authority? Yes* No *If yes, please give full details of disposition on separate sheet. 11. Disclosure of licenses held: Is there any person, registered agent, or anyone holding a five percent interest or more in this business who holds another alcohol license in any retail category or any license under any wholesale category? Yes* No *If yes, please give full details on separate sheet. 12. Disclosure of felony/other convictions or offenses: Is there any person, registered agent, or anyone holding a five percent interest or more in this business who: ➢ Has been convicted under any federal, state or local law of any felony or a misdemeanor involving moral turpitude within the past three years? Yes* No *If yes, please give full details on separate sheet including dates, charges, and disposition. ➢ Has been convicted under any federal, state or local law of a misdemeanor, particularly, but not limited to, those involving alcoholic beverages, gambling or tax law violations within the last three years immediately prior to filing of this application? Yes* No *If yes, please give full details on separate sheet including dates, charges, and disposition ➢ Has been found in violation of the ordinances or resolutions of Union County, or any other county or municipality, governing alcoholic beverages licenses within the last three years immediately prior to the filing of this application? Yes* No *If yes, please give full details on separate sheet including dates, charges, and disposition ---PAGE BREAK--- Page 5 2/11/2025 ➢ Has remaining any delinquent ad valorem taxes due Union County or has any outstanding fines, assessments, liens, fi fas, penalties, or judgments due to Union County or is currently in any violation of any Union County ordinance or resolution? Yes* No *If yes, please give full details on separate sheet including dates, charges, and disposition All of the foregoing information is hereby given, and all of the foregoing statements are hereby made under oath, willfully, knowingly and absolutely, and the same is and are hereby sworn to be true under penalty for false swearing as provided by law. IMPORTANT NOTES: • This application will not be considered until it is completed with all required attachments. To be considered, the completed application must be received 16 days prior to a regularly scheduled Union County Alcohol Board Meeting. The Alcohol Board meets the first Tuesday of each month in 2025. • This written application for the license shall be a permanent record as required by the Union County Code. • The Alcohol Board shall act within 45 days from the date of the filing of the completed application. • If the applicant is denied a county or a state license, the deposit representing the initial license fee shall be refunded, but the cost paid for the application, investigation and administrative cost shall be retained. • Any applicant for a license who has in existence at the time of making the new application an existing license shall pay a standard administrative fee of one-half the regular administrative fee but shall pay a separate full initial license fee for each license. • When an applicant is making applications for more than one license at the same time, the applicant shall pay only one administrative fee of 125% of a normal administrative fee but shall pay a separate full license fee for each license. • There shall be an annual license RENEWAL fee for each license - payable prior to November 30th to avoid late fees. The renewal fee will cover the period beginning January 1 and ending December 31, of the next year. • In the event a license is revoked, surrendered, or suspended, there shall be no refund whatsoever. Date: Applicant Signature: Printed Name of Applicant: Business Title of Applicant: ---PAGE BREAK--- Form 2 Page 6 2/11/2025 UNION COUNTY ALCOHOL LICENSING 65 Courthouse Street Blairsville, GA 30512 Phone (706) 439-6000 ~ Fax (706) 439-6004 SAVE AFFIDAVIT (U.S. Citizens are only required to provide this affidavit one time.) By executing this affidavit under oath, as an applicant for a Union County Alcohol License as referenced in O.C.G.A. § 50-36-1, from the Union County Commissioner’s Office, the undersigned applicant verifies one of the following with respect to the application for a public benefit: Please check one box only: 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. Alien Number: 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 with this affidavit. The secure and verifiable document provided with this affidavit can best be classified as: (Type of Document) In making this 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 SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF Signature of Applicant: Printed Name: Date: Notary Public Signature: My Commission Expires: FORM #2 Affix Notary Stamp/Seal Here. ---PAGE BREAK--- Form 2 Page 7 2/11/2025 SECURE AND VERIFIABLE DOCUMENTS UNDER O.C.G.A. § 50-36-2 [Issued August 1, 2011 by the Office of the Attorney General, Georgia] 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. INDICATE AND ATTACH A COPY OF THE DOCUMENT (front and back). □ United States passport or passport card □ United States military identification card □ Merchant Mariner Document or Merchant Mariner Credential issued by the United States Coast Guard □ Secure Electronic Network for Travelers Rapid Inspection (SENTRI) card □ Driver’s license issued by one of the United States, the District of Columbia, the Commonwealth of the Northern Marianas Islands, the United States Virgin Island, American Somoa, 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. □ 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. □ Tribal 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. □ Passport issued by a foreign government □ Free and Secure Trade (FAST) card □ NEXUS card □ United States Permanent Resident Card or Alien Registration Receipt Card □ Employment Authorization Document that contains a photograph of the bearer. □ Certificate of Citizenship issued by the United States Department of Citizenship and Immigration Services (USCIS) [Form N-560 or Form N-561] □ Certificate of Naturalization issued by the United States Department of Citizenship and Immigration Services (USCIS) [Form N-550 or Form N-570] ---PAGE BREAK--- Form 3a Page 8 2/11/2025 UNION COUNTY ALCOHOL LICENSING 65 Courthouse Street Blairsville, GA 30512 Phone (706) 439-6000 ~ Fax (706) 439-6004 APPLICANT BACKGROUND CHECK CONSENT FORM AGENCY REQUESTING HISTORY: UNION COUNTY ALCOHOL BOARD FEE RECEIVED: Check Money Order Cash (OFFICIAL USE ONLY) AMOUNT DATE RECEIPT # To complete this portion of the Alcohol License Application, the following items should be presented at Commissioner’s Office: 1. Completed and notarized forms #3a, 3b, & 3c. 2. An investigative fee of $72.50 in the form of check, money order, or cash. * Checks should be made out to Union County. 3. Valid government issued photo I.D. 4. Applicant should also take $10 to the Sheriff’s Office for fingerprinting. APPLICANT (Print) Full Legal Name: SSN: Home Address: __Phone: City: State Zip Code Sex: Race: Height: Weight: Hair: Eyes: Date of Birth: State of Birth: EMPLOYMENT ( Print) Employer Name: Phone: Employer Address: The undersigned does hereby authorize the Union County Sheriff’s Office to fingerprint and conduct a background investigation, including criminal history record, pertaining to the undersigned which may be in the files of any state, federal, or local criminal agency in the United States and report the findings to the Union County Commissioner’s Office. Applicant signature: Date: SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF Notary Public Signature: My Commission Expires: FORM #3a Affix Notary Stamp/Seal Here. ---PAGE BREAK--- Form 3b Page 9 2/11/2025 UNION COUNTY SHERIFF’S OFFICE BACKGROUND INVESTIGATION AND CRIMINAL HISTORY REPORT This is to certify that we have conducted a background investigation and criminal history pertaining to: which may be in the files of any state, Name of Applicant Federal, or local criminal agency in the United States. As a result of such investigation, we find: The above-named individual HAS NOT been convicted of any federal, state or local law of any drug or alcohol related offense, weapons violation, or related offenses, within the past three years. The above-named individual HAS no arrest history The above-named individual HAS the following arrest record and/or convictions as listed below within the past three years ARREST Arrest DATE Conviction Y/N Conviction DATE day Officer running Criminal History Note: This form, when completed, must be delivered by the Sheriff’s Office directly to Union County Commissioner’s Office, otherwise the report is null and void. FORM #3b ---PAGE BREAK--- Form 4 Page 10 2/11/2025 Name-Based Criminal History Record Information Consent/Inquiry Form I hereby authorize the ALCOHOL BOARD OF UNION COUNTY to conduct a Criminal History Background inquiry for the purpose listed below and receive any Georgia and/or national criminal history record information as authorized by state and federal law. Complete Legal Name (print) Current Street Address (Including City, State and Zip) Sex Race Date of Birth Social Security Number CHECK ONE BOX  This authorization is valid for 90 days from the date of signature.  I give consent to the above-named entity to perform periodic criminal history background checks for the duration of my employment. PURPOSE CODE USED: (Check One) NON-CRIMINAL JUSTICE PURPOSES E – Employment M – Working with Mentally Disabled PROVIDING 24/7 CARE N – Working with Elderly W – Working with Children NOT A VOLUNTEER Signature Date FORM #3C ---PAGE BREAK--- Form 4 Page 11 2/11/2025 UNION COUNTY ALCOHOL LICENSING 65 Courthouse Street Blairsville, GA 30512 Phone (706) 439-6000 ~ Fax (706) 439-6004 REGISTERED AGENT CONSENT FORM 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 ordinance regulating the sale of alcoholic beverages in the unincorporated areas of Union County, Georgia. The address for service upon me, as Registered Agent is as follows: Printed Name of Registered Agent: Address of Registered Agent: City: State: Zip: Phone: Email: I understand the basic purpose is to have and continuously maintain in the county – 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. Registered Agent Signature: Date: Business Owner Approval: Date: SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF Notary Public Signature: My Commission Expires: Business Name: Business LOCATION address: City: State: Zip: To complete this portion of the Alcohol Licensing process, please provide the following information: 1. Completed Form 2. Government Issued Photo I.D. of Registered Agent 3. Copy of utility bill or mail validating Union County residency. 4. If Changing Registered Agent, include check for $100 FORM #4 Affix Notary Stamp/Seal Here. ---PAGE BREAK--- Form 5 Page 12 2/11/2025 UNION COUNTY ALCOHOL LICENSING 65 Courthouse Street Blairsville, GA 30512 Phone (706) 439-6000 ~ Fax (706) 439-6004 STATE OF GEORGIA, COUNTY OF UNION APPLICANT AFFIDAVIT REGARDING TRAINING BEFORE ME, the undersigned authority, personally appeared (print name) who after being first duly sworn, deposes and says: 1. I am an applicant for an alcoholic Beverage License from Union County, Georgia. 2. If I am granted a license, I affirm that prior to any sales or services of alcoholic beverages, all employees, managers, cashiers, and servers, or future employees, managers, cashiers, and servers will be trained in the regulations governing the sale of alcoholic beverages prior to being allowed to sell or serve. 3. The training shall consist at a minimum of either written or video training materials recognized and approved as appropriate training by Union County. 4. I understand that this is an annual requirement to be completed by July 30. 5. I am attaching a copy of the policies and procedures for such sales and services to this affidavit. FURTHER AFFIANT SAYETH NAUGHT. Signature of Applicant SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF Notary Public Signature: My Commission Expires: FORM #5 Affix Notary Stamp/Seal Here. ---PAGE BREAK--- Form 6 Page 13 2/11/2025 UNION COUNTY ALCOHOL LICENSING 65 Courthouse Street Blairsville, GA 30512 Phone (706) 439-6000 ~ Fax (706) 439-6004 TAX DELINQUENCY CERTIFICATION Name of Business: Address of Business: Tax Identification Numbers: There are no delinquent taxes owing to Union County, Georgia either upon real property or personal property by any of the following named persons or entities: Alcohol License Applicant (please print): Owner: Other Parties of Interest in Business: FOR OFFICIAL USE ONLY: I have examined the tax records of Union County and find no delinquent taxes against the property or individuals listed above. This day of 2025 County Agent Please note: A Tax Delinquency Certification must be obtained each year when renewal applications are made. FORM #6 ---PAGE BREAK--- Form 7 Page 14 2/11/2025 UNION COUNTY ALCOHOL LICENSING 65 Courthouse Street Blairsville, GA 30512 Phone (706) 439-6000 ~ Fax (706) 439-6004 SAFETY COMPLIANCE FORM Name: Phone: Location Address City State Zip Code 1. Type of Business: Restaurant Hotel/Motel Wine & Craft Beer Grocery Store Bed & Breakfast Wholesaler Convenience Store Farm Winery Distillery Other - Please Explain 2. Distance to School Building, School Grounds, or Alcohol Treatment Center: For distilled spirits, is the distance more than 200 yards of any school building, school grounds, or college campus? Yes No N/A For distilled spirits, is the distance more than 100 yards of any church building? Yes No N/A For wine or malt beverages is the distance more than 100 yards of any school building, school grounds, or college campus? Yes No N/A Is entrance to building more than 100 yards of any alcohol treatment center owned and operated by this State or any County or Municipal Government? Yes No N/A 3. Safety Compliance Checklist: Yes No N/A Does building location front a highway or paved road? Is building entrance/s and exits/s handicap accessible? Is building restroom/s handicap compliant? Is exit lighting installed at required exits and exit pathways? Are exit pathways clear and unobstructed? Are visible portions of electrical system installed correctly and working? Seats allowed. Does location meet seating capacity? Is exterior alcohol-related signage absent from premises? Is parking lot lighting in alignment with ordinance requirements? Are building/parking areas in good repair, clean, and well maintained? Comments: FORM #7 FOR OFFICIAL USE ONLY: Acceptable Unacceptable Inspection Initials ---PAGE BREAK--- Form 9 Page 15 2/11/2025 UNION COUNTY, GEORGIA ALCOHOL LICENSING DEPARTMENT By the Package Alcohol Sales Report (Reports are due January 30 and July 30 of each year) Reporting Period: January – June 20__ July – December 20__ BUSINESS NAME: County License # Address: State License # A. Gross Alcohol Sales for reporting period $ B. Gross Sales of items other than Alcohol for reporting period + $ C. Gross Sales for reporting period = $ Percentage of non-alcohol gross sales B/C = % Alcohol Ordinance: 10-76 All licensed establishments shall submit to the county at least semi-annually, on or before January 30 and July 30 of each year, or as at such other times as requested, summaries of financial records showing compliance with the required percentage sales requirements, together with copies of back-up documentation, or the electronic equivalent if the county or Alcohol Board agrees. 10-78 Malt beverages and wine may be sold by the package in grocery stores and convenience stores which derive at least sixty percent (60%) of their gross receipts semi-annually from the sale of items other than malt beverages, wine. 10-78 An establishment issued a license under this Ordinance shall be under a responsibility to demonstrate and provide regular proof that the business location for which the license is issued derives at least sixty percent (60%) of total gross sales from the sale of items other than malt beverages, or wine. I hereby certify that the statements made herein and in any supporting schedules are true, correct, and complete to the best of my knowledge. Printed Name Signature of Preparer Date Phone # Email Address FORM #8 ---PAGE BREAK--- Form 8 Page 16 2/11/2025 UNION COUNTY, GEORGIA ALCOHOL LICENSING DEPARTMENT Consumption on the Premises Alcohol Sales Report (Reports are due January 30 and July 30 of each year) Reporting Period: January – June 20__ July – December 20__ BUSINESS NAME: County License # Address: State License # A. Gross Food Sales for reporting period $ B. Gross Alcohol Sales for reporting period + $ C. Gross Sales for reporting period = $ 1. For a business serving food, percentage of gross food sales A/C= % 2. For a business serving food, percentage of gross alcohol sales. B/C= % Alcohol Ordinance: 10-76 All licensed establishments shall submit to the county at least semi-annually, on or before January 30 and July 30 of each year, or as at such other times as requested, summaries of financial records showing compliance with the required percentage sales requirements, together with copies of back-up documentation, or the electronic equivalent if the county or Alcohol Board agrees. 10-77 Such eating establishment will regularly serve food every hour they are open and derive at least sixty percent (60%) of its gross receipts annually from the sale of prepared meals or food and derive no more than forty percent (40 from the sale of alcoholic beverages. 10-77 An eating establishment issued a license under this article shall be under a responsibility to demonstrate and provide regular proof that the business location for which the license is issued has gross sales from the sale of prepared meals or food of at least sixty percent (60%) of total gross sales of the business. I hereby certify that the statements made herein and in any supporting schedules are true, correct, and complete to the best of my knowledge. Printed Name Signature of Preparer Date Phone # Email Address FORM #9 ---PAGE BREAK--- Form 10 Page 17 2/11/2025 UNION COUNTY, GEORGIA ALCOHOL LICENSING DEPARTMENT Consumption on Premises – Alcohol by the Drink Distilled Spirits Excise Tax Report and Food Sales Report Period Reported: , BUSINESS NAME: County License # Address: State License # Gross Food Receipts for the month: Gross Alcohol Receipts for the month (Beer, Wine, Distilled Spirits) Gross Taxable Receipts for the month (Distilled Spirits Only) Three percent tax due on Gross Distilled Spirits Receipts Less 3% Discount: (if remitted on or before the 10th day of succeeding month) Add .75% penalty: (if remitted on or after the 20th day of succeeding month) NET TAX DUE ON DISTILLED SPIRITS Excise Tax payments on Distilled Spirits are required under Section 10-90 of the Union County Alcohol Ordinance. 1. I understand that a penalty of .75% of the tax amount is due for failure to remit tax on or before the 20th of the succeeding month. 2. I understand that if the county commission deems it necessary to conduct an audit of the records and books of the licensee, they will notify the licensee of the date, time, and place of the audit. 3. I understand that any licensee who violates any provision of this section may, upon conviction, be punished by a fine of 25 percent of the tax owed in addition to interest as set forth in the ordinance. 4. I further understand that if my establishment fails to meet the appropriate percentage requirement for the sale of food my license shall be subject to possible suspension or revocation. 5. I HEREBY CERTIFY THAT THE STATEMENTS MADE HEREIN AND IN ANY SUPPORTING SCHEDULES ARE TRUE, CORRECT, AND COMPLETE TO THE BEST OF MY KNOWLEDGE. Printed Name Signature of Preparer Date Phone # Email Address Make check payable to Union County – Hand Deliver or mail to Union County Commissioner’s Office, 65 Courthouse Street, Blairsville, GA 30512 – [PHONE REDACTED] – Fax [PHONE REDACTED] FORM #10