For Office Use Only NOI Permit #: Posters for all Retail Alcoholic Beverage Permits Office of Alcohol and Tobacco Control 8585 Archives Ave., Suite 220 ● Baton Rouge, LA 70809 Telephone: 225.925.4041 ● Fax: 225.925-7652 www.atc.rev.state.la.us NOTICE OF INTENT POSTER REQUIRED FOR ALL RETAIL ALCOHOLIC BEVERAGE PERMITS ● VALID FOR 90 DAYS Page 1 of 2 IMPORTANT NOTICE ● If you are starting a new business, this application must be completed, signed, notarized, and submitted, along with the appropriate fees at least 15 days prior to submitting your application for an alcoholic beverage permit; ● If you are taking over an ongoing business that has held a valid, state-issued alcoholic beverage permit within the past 6 months, the alcoholic beverage permit application may be submitted, along with this application; ● As required by law, the Notice of Intent poster must be posted in plain view outside the business location for 15 days. PERMIT CLASS AND TYPE 1. Please mark the Class of permit that you desire: 2. Please mark the Type of alcoholic beverage(s) that you intend to sell: Class A – General (On-Premises Consumption) [RS 26:71.1(1) / 271.1(1) Class A – Restaurant (On-Premises Consumption) [RS 26:73(c)/273(c)] Beer Class A – Caterer Liquor (LAC 55, VII 325) Light Wine (Not needed if Liquor is checked; Must have “R” permit) Class B – (Off-Premises Consumption ONLY) [RS 26:2(13) / 241(13)] Class C – (Off-Premises Consumption ONLY) [RS 26:71.2(13 )/ 271.2] BUSINESS INFORMATION 3. Type of Ownership Individual 4. Owner Name of Business (Individual, Partnership, Corporation, LLC) Partnership Corporation LLC 5. Location Address 6. Trade Name of Business Street 7. Location Parish City State Zip 8. Has this location held a valid, state-issued beer/liquor permit within the last 6 months? ● If Yes, enter the trade name under which the business operated: Trade Name Yes No . APPLICANT INFORMATION 9. Applicant’s Name 10. Driver’s License # and State Issued 11. Mailing Address 12. Contact Information State DL# P. O. Box/Street City Cell ph. # State Zip ( ) - Home ph. # ( ) - Work ph. # ) - E-mail Address American LegalNet, Inc. www.FormsWorkFlow.com FEES 13. Please check the type of alcoholic beverage to be served, and enclose the appropriate amount with this application: $50.00 – BEER (Low Alcohol Content) $50.00 – LIQUOR (High Alcohol Content) $50.00 – LIGHT WINE ONLY NOTE ● Not needed if Liquor is checked; “R” Permit is required. ● NO REFUNDS will be made once this application packet and fees have been reviewed by this office; ● Our office accepts: money orders, cashier’s checks and certified checks. DO NOT SEND CASH OR PERSONAL/BUSINESS checks; ● Make all payments payable to: Office of Alcohol and Tobacco Control; ● Cash is only accepted at the Baton Rouge Office. The cashier’s window is open during the hours of 8:00 a.m. through 4:00 p.m., Monday through Friday, excluding holidays; ● Mail fully-completed forms, all supporting documents, and proper fees to: Office of Alcohol and Tobacco Control 8585 Archives Ave., Suite 220 Baton Rouge, LA 70809 SWORN STATEMENT your Signature: Print your Name: Title: ______________________________________________________ Sworn to and subscribed before in the Parish of day of ,20 State of _________________________________ _______________________________ print name of notary public: Signature: NOTARY PUBLIC FOR OFFICE USE ONLY Poster Serial # ____________________ Date Issued ____________________ Receipt # ____________________ Issued by ____________________ Poster Serial # ____________________ Date Issued ____________________ Receipt # ____________________ Issued by ____________________ Poster Serial # ____________________ Date Issued ____________________ Receipt # ____________________ Issued by ____________________ American LegalNet, Inc. www.FormsWorkFlow.com