Ohio Department of Commerce Division of Liquor Control 6606 Tussing Road, P.O. Box 4005, Reynoldsburg, Ohio 43068-9005 Telephone No. (614) 387-7407 - Fax No. (614) 644-6965 http://www.com.ohio.gov/liqr F-2 PERMIT APPLICATION Fee: $150.00; $160.00 if issued jointly with the holder of a D-permit holder. An F-2 permit may be issued to an association, corporation, or to a recognized subordinate lodge, chapter, or other local unit of an association or corporation organized not for profit and operated for a charitable, cultural, fraternal, educational or political purpose to sell beer and intoxicating liquor until 1:00 a.m., at an event not to exceed four consecutive days. The applicant may not be affiliated with the holder of any class of liquor permit other than a D-4 permit. No more than one F-2 permit may be issued to any applicant in a 30 day period. APPLICATION SHOULD BE FILED THIRTY (30) DAYS PRIOR TO EVENT CAREFULLY READ THE GENERAL INSTRUCTIONS FOR FILING F-2 APPLICATION ON PAGE 3 TYPE OR PRINT PLAINLY Email Address: ALL QUESTIONS MUST BE ANSWERED (Note: This is for notification purpose only - NOT for emailing correspendence) Name of Non-Profit Organization (Exact Name must be uniform on all documents - please do not abbreviate) Street Address (Where Function Will Be Held - BE SPECIFIC & must be uniform on all documents - For Street Closures see Address Addendum -Page 1(A) Township (Only if Unincorporated Area) City State OHIO Zip Code County: Mail and/or Fax Permit and Correspondence To: Name: State: Zip Code: Name: Phone #: Time Function Begins: (Month/ Day/ Year) Date and Time Function Will End: Date Function Ends: (Month/ Day/ Year) Time Function Ends: Street Address: Phone #: City: Fax #: Title: Individual responsible for the compliance with Ohio's liquor laws in conjunction with the sale and consumption of alcoholic beverages: Date and Time Function Will Begin: Date Function Begins: am am pm pm The Division of Liquor Control does not regulate or advise individuals regarding gambling in conjunction with the issuance of an F2 permit. Any question regarding gambling should be directed to the Ohio Attorney General's Office, Charitable Gaming Section, 101 East Town Street, Columbus, OH 43215 at (614) 466-3180. SECTION A 1. Has any officer of the applicant organization, or the organization itself ever been convicted of any felony or misdemeanor not previously reported to the Division of Liquor Control? If YES, attach a written explanation. 2. Will a holder of a liquor license (D-permit holder) be conducting the sale of alcoholic beverages? If YES, this application may be filed jointly. Please indicate below the permit holder's name and permit number. (Note: Both F2 applicant name and issued permit holder name must be on all documents where "Name of Non Profit Organization is requested) Permit Holders Name: YES YES NO NO Permit Number: FOR OFFICE USE ONLY Taxing District Permit Number Receipt # DLC 4138 Rev. 10-2014 American LegalNet, Inc. www.FormsWorkFlow.com Reviewer Action: Remarks: EOE/ADA SERVICE PROVIDER FOR TTY USERS DIAL ORS 1-800-750-0750 ADDRESS ADDENDUM This Addendum is to be used if there will be any type of street, alley, or public sidewalk closure. Additionally, please attach an acknowledgement from the legislative or local police authority in control authorizing the closure. If the premise covers an area that includes adjacent streets, alleys, or public sidewalks that will be closed, please list and identify the street name and address/street range (i.e., Main Street - From 600 Block To 700 Block) NOTE: Include a copy of this form to both the Chief Peace Officer and Real Property Owner listed in Sections A & B on Page 4 of this application. STREET NAME ADDRESS or STREET RANGE FROM TO DLC 4138 Page 1(A) American LegalNet, Inc. www.FormsWorkFlow.com SECTION A continued: 3. Is the applicant a not for profit association, corporation, or a recognized subordinate lodge, chapter, or other local unit of an association or corporation? If "YES", list the name: ______________________________________________________ 4. If requested, is the applicant able to provide the Division of Liquor Control evidence from the Ohio Secretary of State's office that the applicant is a valid not for profit association, corporation, or a recognized subordinate lodge, chapter, or other local unit of a not for profit association or corporation? If NO, please explain: Will 100% of the proceeds, less expenses, from the applicant's sale of alcoholic beverages either be retained by the applicant or distributed by the applicant for non-profit charities, cultural, fraternal, political or educational programs? If "NO", please give detailed explanation: YES NO YES NO 5. YES NO 6. 7. Is applicant an owner, shareholder, managing member, or officer of any class of liquor permit other than D-4? If YES, please explain: ____________________________________________________________________________ Will any individual or for profit association, corporation, or other legal entity receive any portion of the proceeds after expenses from the event for which you are requesting the F-2 permit? If YES, please explain, identifying share of profit or gain each person will receive: YES NO YES NO 8. Will the members of the applicant organization coordinate and operate the event and conduct the sale of alcoholic beverages? If NO, please attach a detailed explanation of the non member involvement and their financial compensation. Please check the specific purpose for which your organization operates: Educational Charitable Cultural Fraternal YES NO 9. Political 10. What is the purpose of the event? (Note: The proceeds of the function shall not be used for the profit or gain of any individuals) THE FOLLOWING MUST BE COMPLETED BY THE APPLICANT(S): NOTE: FALSIFYING ANY OF THE INFORMATION ON THIS APPLICATION CAN RESULT IN THE DIVISION'S REFUSING TO ISSUE THIS PERMIT State of Ohio, ___________________________________County, ss I ___________________________________________________, being first duly sworn, according to law, depose and say that I am at least twenty-one (21) years of age and the statements and answers made in the foregoing application are true. With respect to the F-2 permit, I agree to comply with all applicable statutes and administrative rules. I hereby acknowledge that I am required by law to be responsible for any conduct that violates laws pertaining to the sale of alcoholic beverages, and that both parti