Idaho State Police Alcohol Beverage Control 700 S. Stratford Dr. Ste 115 Meridian, ID 83642 (208) 884-7060 Incorporated City Priority List Liquor License Application 1. City and County for the proposed license: _____________________________________ 2. License Type and Fees 3. Applicant Information Application Fee Enclosed $ ____________ Business must be located within the incorporated city limits of the city being applied for. Applicant Name: ______________________________________________________________ Mailing Address: _______________________________________________________________________ City, State, Zip: _______________________________________________________________________ Daytime Telephone: _____________________ Nighttime Telephone: ____________________________ Federal or State Tax I.D. Number for Corp., LLC or Partnership: _______________________________ SSN for Individual(s)/Sole Proprietor(s): ___________________________________ (Applicant Name: Individual(s), Corporation, LLC or Partnership) 4. List sole proprietor(s) or all partners, corporate officers, directors, ten primary stockholders, LLC/LLP members/partners of the applicant. Attach a separate sheet of paper following the format below. Name: ______________________________________ Address: __________________________________________ Title: _____________________ SSN: ______________________________ DoB: ____________________________ Idaho Resident: (Y/N) _________________________ If `YES' length of residency: __________________________ 5. Read the following, Sign and have notarized. The applicant hereby swears or affirms under oath that the applicant is the bona fide owner of the business which will be engaged in the sale or dispensing of liquor by the drink, beer and/or wine by the bottle and/or glass upon issuance of the license. The applicant hereby affirms that the applicant is eligible and has none of the disqualifications for a license as provided by Title 23, Chapter 9, 10, 11, 13 and 14, Idaho Code or any amendments thereto. Applicant further acknowledges that they and/or each person indicated on this application or attachments understand that state law controlling alcohol beverage licensing is found at Title 23, Idaho Code and the Alcohol Beverage Control administrative rules found at IDAPA .05.01, and that any violation of these laws or rules can result in criminal and/or administrative sanctions, and up to and including license revocation. I/we, the applicant of this license, have read all of the above and declare under penalty of perjury that the information that I/we have provided is true and correct to the best of my/our knowledge. ____________________________________ ____________________ _______________ Authorized Agent or Applicant's Signature ______________________________________________________ Authorized Agent/Applicant's Printed Name Title Date Subscribed and sworn to before me this ______ day of ______________, 20____. __________________________________________ (Seal) Residing At_____________________________________ My Commission Expires: _________________________ Notary Public EH 10.02-09 Rev 03/2013 American LegalNet, Inc. www.FormsWorkFlow.com ALCOHOL BEVERAGE CONTROL 700 S. Stratford Dr. Ste 115 Meridian, ID 83642 (208) 884-7060, ABC@isp.idaho.gov INSTRUCTIONS FOR PRIORITY LIQUOR WAITING LIST � � � � Forms must be legible (Print or Type) All blanks must be completed. Follow all instructions printed on each form. An incomplete application will be returned. All forms must be signed and notarized. Fees must accompany the application. Do not mail cash. Completing the application: Instructions follow the order of the application. 1. City and County for the proposed license: Write the city and county that you would like to be issued a license for. 2. License Type and Fees: The fee for the future liquor waiting list is 1/2 the annual renewal fee for the liquor license in the city for which you are applying for. Ex. Boise City - $375 ($750 annual). McCall - $250 ($500 annual). 3. Applicant Information: Write in all of the required information as listed. N/A is not acceptable. a. Applicant means: Individual(s), partnership, corporation, LLC, or association that will be conducting the business 4. List of Applicants/Agents: List all persons associated with the applicant. Follow the format listed and attach a separate sheet of paper if necessary. 5. Read, sign and have notarized. Upon receipt of your completed application, your name will be entered at the bottom of the waiting list for the city you chose. Licenses are issued by increase in the population. ABC receives estimated population statistics from the Dept. of Commerce/US Census Bureau each year and actual population statistics every 10 years. Licenses are offered to applicants starting at the top of the list. In order to assist ABC in notifying you when you are at the top of the list, you must notify our office in writing if you have a change of address. If we cannot locate you to offer you a license, your name will be removed and deposit refunded. A list is not maintained for cities that are not incorporated or that do not allow the sale of liquor. For more information see IDAPA Rules 11.05.01.013. Rev. 10/2010 American LegalNet, Inc. www.FormsWorkFlow.com