DCPLC - LGB INST / DOCS rev 9/12 STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION Liquor Control Division Telephone: (860) 713-6210 Web Site: www.ct.gov/dcp INSTRUCTIONS AND INFORMATION: Grocery Beer Liquor Permit Application PLEASE READ ALL INSTRUCTIONS AND INFORMATION BEFORE COMPLETING APPLICATION. APPLICATION WILL NOT BE ACCEPTED IF INCOMPLETE OR IF ANY REQUIRED DOCUMENT IS MISSING. Fees and Form of Payment: The total filing fee of $270.00 for annual sales of food and grocery items totaling less than $2 Million or $1600.00 for annual sales of food and grocery items totaling more than $2 Million is required for successful submission of this application. Checks and/or money orders should be made payable to "Treasurer, State of Connecticut" and must accompany this application. The application filing fee of $100.00 is included in the total filing fee and is not refundable. If you are filing the application in person with the department, cash may be accepted. You may not submit cash via mail. The Application Process **Once we are in receipt of your complete and correctly executed application and filing fee, a Liquor Placard will be mailed to you with additional instructions for public notification. The placarding process is critical to application approval. A placarding error can delay a permit approval at least two additional months. A Liquor Control Agent will then be assigned to your file and will contact you to begin the remainder of the new application process. If you have requested a Provisional Permit, please refer to the page entitled "Provisional Permit" in this application packet. If for any reason a Final Liquor Permit is not issued within a period of one year, you will be required to file another application.** Definitions Permittee ­ The permittee is the applicant for the liquor permit. The permittee is a person designated as the representative of the backer for the permit premises. The permittee must be able to read and understand English. The permittee can be the owner/backer of the business that holds the permit. Backer ­ An individual or legal business entity that owns the business to which the liquor permit is issued. Authorized Backer Representative ­ An individual who is legally authorized by the nature of the position held (i.e. corporate officer) in the business, or through a power of attorney to sign documents and make decisions related to the liquor permit. **Section 30-45 of the Connecticut General Statutes prohibits the following individuals and officer holders from obtaining a liquor permit. Section 30-45 appears below and the prohibited individuals are noted. If you are a prohibited individual, you may not apply for a liquor permit. CT General Statutes, Section 30-45: The department of consumer protection shall refuse permits for the sale of alcoholic liquor to the following persons (1) Any sheriff, deputy sheriff, judge of any court, prosecuting officer or member of any police force, (2) a minor, and (3) any constable who performs criminal law enforcement duties and is considered a peace officer by town ordinance pursuant to the provisions of subsection (a) of section 54-1f, any constable who is certified under the provisions of sections 7-294a to 7-294e, inclusive, who performs criminal law enforcement duties pursuant to the provisions of subsection (c) of section 54-1f, or any special constable appointed pursuant to section 7-92. This section shall not apply to out-of-state shippers', boat and airline permits. As used in this section, "minor" means a minor as defined in section 1-1d or as defined in section 30-1, whichever age is older. American LegalNet, Inc. www.FormsWorkFlow.com DCPLC - LGB INST / DOCS rev 9/12 APPLICATION INSTRUCTIONS AND DOCUMENTS REQUIRED FOR A GROCERY BEER LIQUOR PERMIT APPLICATION TO BE ACCEPTED 1. APPLICATION FOR GROCERY BEER LIQUOR PERMIT Complete all three pages of application. Every question must be answered, and all necessary approvals obtained (zoning and town clerk) If left blank, the application will not be accepted. If the question does not apply, enter the word "none". Completing the Application Section A: Business Information Item #1 through #7 ­ Complete this section with type of permit selected, trade name and business information. If you are applying for a provisional permit, please complete the Provisional Permit and Credit Waiver Request form (DCPLC-Provisional Permit Request) included in this application package. Section B: Approval of Local Officials Items #8 and #9 need to be signed and completed by your local public officials. No applications will be accepted without local zoning approval and town clerk certification. Section C: Permittee Applicant Information Item #10 through #14 please enter name, address and contact information for permittee. Section D: Preferred Mailing Address Items #15 and #16 .Indicate the preferred mailing address for all correspondence. If you would like correspondence mailed to an address other than the business or permittee home address, specify in #15 and #16. Section E: Backer Information Item #17 through #23 ­ Provide correct backer name in #18. Backer name is the name of the Limited Liability Company or Corporation that is registered with the Secretary of the State or the individual name of the Sole Owner that has not formed a LLC or Corporation or the individual names of a Partnership that has not formed a LLC or Corporation, etc. Section F: Current or Previous Liquor Permits Held By Permittee or Backer Item #24 through #26 ­ List current or previously held liquor permits. Include any permits held by permittee, backer, sole proprietor, partner or a member of a partnership organization, corporation, limited liability company etc. If there are none, check "NO" in #24a and #24b. Section G: Certification of Permittee Applicant and Backer or Authorized Representative of Backer Items #27 and #28 - The permittee listed in Section C #10 of the application must sign #27. The backer/owner listed in Section E or authorized backer representative must sign #28. 2. FEE AND FORM OF PAYMENT: The total filing fee of $270.00 for annual sales of food and grocery items totaling less than $2 Million or $1600.00 for annual sales of food and grocery items totaling more than $2 Million is required for successful submission of this application.. Checks and/or money orders should be made payable to "Treasurer, State of Connecticut" and must accompany this application. The application filing