HomeMy WebLinkAboutappendix_b_retailer_beer_and-or_wine_license_form_a1
35 North 1st East (PO Box 280) Phone: 208-359-3020 x2313
Rexburg, Idaho 83440 Fax: 208-359-3022
www.rexburg.org blair.kay@rexburg.org
APPENDIX B - APPLICATION FOR RETAILER'S LICENSE TO SELL:
BEER ONLY
WINE ONLY
BEER AND WINE
I (or we) the undersigned, make application for a license to sell beer and/or wine, as a retailer within
the City of Rexburg, Idaho, and for the purpose represent:
The name of the business is: _____________________________________________________
Address of business: _________________________________________________________
___________________________________________________________________________
Business to be conducted thereon by the applicant: ___________________________________.
Address of applicant: _________________________________________________________
___________________________________________________________________________
Phone: _________________________ Email: ______________________________________
Length of residence in the State of Idaho: __________________________________________
I am applying for a beer and/or wine license to sell: (on premises); (off premises)
Ordinance 942:
A.(Off premises) where the applicant applies for a license to sell as a retailer, only bottled or canned beer
and wine, none of which is consumed, or to be consumed, on the premises where sold, the license fee
shall be $50.00 for beer and $50.00 for wine per year until such fee is amended by resolution
of the Council.
B.(On premises) where the applicant applies for a license to sell beer and/or wine as a retailer for consumption on
premises:
1.Draft beer and bottled or canned beer only, the amount of the license fee shall be $200.00
per year, or if
2.Bottled, boxed or canned wine only, the amount of the license fee shall be $200.00 per year.
Note: The license year begins October 01st and ends September 30th. The fee will be prorated to (50%) for a half year
with applications after March 31st.
C U ST OM ER S UPPORT
S E RV I C ES
TRAVEL REQUEST FORM
X
X
2
If applicant is a partnership, names, contact information and places of residence of each
partner:
Full Name: ___________________________
Address: _____________________________
City: ________________ State: ___________
Zip: __________
Phone: ___________________________
Email: ____________________________
Full Name: ___________________________
Address: _____________________________
City: ___________ State: ________________
Zip: ____________
Phone: ___________________________
Email: ____________________________
If applicant is a corporation or association, the date and place of incorporation or
organization, the location of its principal place of business in Idaho and the names and
places of residence of its officers, directors or members of its governing board.
Date & Place of Incorporation or organization: ________________________________________
_____________________________________________________________________________
Principal Place of Business in Idaho: ________________________________________________
Names of Officers: ___________________ _______________________ _________________
___________________ _______________________ _________________
Name and residence of person who manages or will manage the business of selling beer at retail:
_____________________________________________________________________________
Manager Phone: ____________________ Manager Email: ______________________________
This is to certify:
(a)That applicant: _____________________________ is the bona fide owner of the business
which will be engaged in the sale of beer at retail and with respect to which license is sought;
(b) That the condition of the place or building wherein it is proposed to sell beer at
retail conforms to all laws and regulations of the state of Idaho and to the
ordinances of the county and municipality applicable thereto relating to public health
and safety and to the zoning ordinances of the municipality applicable thereto:
(c) That the individual applicant, or each partner of a partnership applicant, is a
citizen of the United States; or, with respect to a corporation or association, that
is qualified to do business with the state of Idaho and that the person who is or will
be the manager of the corporation's or association’s business of selling beer at
retail is a citizen; further, that such individual applicant, at least one (1) of the
partners of the partnership applicant, and said manager of the corporation or
association applicant, shall have been a bona fide resident of the state of Idaho for
at least thirty (30) days prior to the date of application;
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(d) That the applicant, if an individual, is not less than nineteen (19) years of age;
(e) That within three (3) years immediately preceding the date of filing the
application, the applicant has not been convicted of the violation of any law of the
State of Idaho, any other state, or of the United State, regulating, governing or,
prohibiting the sale, manufacture, transportation or possession of alcoholic beverages
or intoxicating liquors, or within said time, suffered the forfeiture of a bond for
failure to appear in answer to charges of any such violation;
(f) That within five (5) years immediately preceding the date of filing the
application, the applicant has not been convicted of any felony or paid any fine or
completed any sentence of confinement therefore within said time;
(g) That within three (3) years next, preceding the date of filing the application,
the applicant has not had any license provided for herein, or any license or permit
issued to the applicant pursuant to the law of this state or any other state, or of
the United States, to sell, manufacture, transport or possess beer, revoked.
That I will observe all requirements of the City of Rexburg relating to the hours of closing and will
not sell or dispense beer in violation of any such ordinance.
I FURTHER DECLARE that I have read the foregoing application, that I understand the same
and agree to all statements therein contained.
Signature: __________________________________ Date: ______________________
___________________________
Blair D. Kay, City Clerk
Revised: July 3, 2017
Office Use Only
Registration No.____________
CC Approval Date___________