Application For Special Event Permit Form. This is a Louisiana form and can be use in Office Of Alcohol And Tobacco Control Statewide.
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State of Louisiana Department of Revenue Office of Alcohol and Tobacco Control SPECIAL EVENT PERMIT General Information For Special Events, ATC will issue a special, temporary retail alcoholic beverage permit for the duration of up to three consecutive days only. The wholesaler can deliver beverages only to the place 1isted on the permit, and only on the days allowed by the permit. A maximum of 12 Special Event permits may be issued to any one person, partnership, corporation, or entity within a single calendar year. Special Events are events where alcoholic beverages are sold, or supplied as part of general admission or other type fee. Special events do not include private parties where no sales are made or fee charged, and where the only purpose in applying is to obtain product or services from a wholesale dealer. Notice: All special event permits, regardless of type, are retail alcoholic beverage permits. As such, and in accordance with the provisions of R.S. 26:85 and 273, any organization engaged in business as a manufacturer or wholesaler of alcoholic beverages or any organization whose membership is composed of persons engaged in business as a manufacturer or wholesaler of alcoholic beverages does not qualify for a special event permit. All applicant information must agree with all of the documents submitted. The dates and locations of must be exactly the same on all local and state documents and lease (if applicable). CHECK LIST Three types of special event alcoholic beverage permit are issued the by Office of Alcohol and Tobacco Control: Type A Permits issued to nonprofit organizations with tax exempt status under the U.S. Internal Revenue Code, Section 501 (c)(3) or (c)(8). To qualify for this permit, applicants must submit all of the following: ● Certification from the IRS stating tax exempt status under either Section 501(c)(3) or 501(c)(8); ● A copy of a local permit or letter from the local governing authority granting permission to sell alcoholic beverages; ● A valid, signed and dated lease, contract, or written permission from the property owner; ● A completed and notarized application form; ● This type of permit is issued at no charge. Type B Permits issued to non-profit organizations which are able to provide some type of written proof of their non-profit status, but are unable to show written proof of their tax-exempt status under the U.S. Internal Revenue Code, Section 501 (c)(3) or (c)(8). To qualify for this permit, applicants must submit all of the following: ● ● ● Written proof of non-profit status; A copy of local permit or letter from the local governing authority granting permission to sell alcoholic beverages; A valid, signed and dated lease, contract, or written permission from the property owner; American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 ● ● A completed and notarized application form; $10.00 fee. Type C Permits issued to persons who do not meet the requirements for Type A or Type B Special Event permits. To qualify for a Type C special event permit, applicants must meet the same requirements of a retail permittee found in Louisiana Revised Statute 26:80 and R.S. 26:280, and submit all of the following: ● ● ● ● A copy of local permit or letter from the local governing authority granting permission to sell alcoholic beverages; A valid, signed and dated lease, contract, or written permission from the property owner; A completed and notarized application form. $100 fee. Fees ● ● ● ● Acceptable forms of payment by mail are money order, cashier’s check, or bank certified check; No business checks or personal checks will be accepted by mail; Exact cash can be paid in person, at the Baton Rouge office only, in Baton Rouge, Louisiana. The cashier’s window at the Baton Rouge office is open Monday through Friday, 8:00 a.m. – 4:00 p.m., with the exception of holidays. Applications with applicable fees should be mailed to: Office of Alcohol and Tobacco Control Attention: Certification and Licensing Division 8585 Archives Ave., Suite 220 Baton Rouge, LA 70809 American LegalNet, Inc. www.FormsWorkFlow.com For Office Use Only SE Permit #: Retail Alcoholic Beverage Permit 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 SPECIAL EVENT ● PERMIT LIMITED TO 3 DAYS ONLY ● Page 3 of 2 APPLICANT QUALIFICATIONS ● Must be a citizen of the state of Louisiana; ● Must have resided in the state of Louisiana for the past two (2) years; ● Applicant or applicant’s spouse, and/or applicant’s membership cannot hold interest in any business that holds a wholesaler or manufacturer beer or liquor permit. REQUIRED DOCUMENTATION Refer to the Special Event Permit General Information Sheet and Check List for a list of documents that must be submitted with your application. CLASS OF PERMIT 1. Please check the class of permit for which you are applying: Type A - Type B Type C - Tax-exempt, non-profit status under IRS Code Sections 501(c)(3) and 501(c)(8). Must provide written proof of tax-exempt status. No fee is required for this permit. Non-profit organization. Must provide written proof of non-profit status. $10.00 fee. All other individuals and organizations. $100 fee. EVENT AND APPLICANT INFORMATION NOTE IF YOU ARE APPLYING FOR A TYPE C PERMIT, THIS APPLICATION MUST BE COMPLETED AND SIGNED BY AN OWNER, PARTNER OR OFFICER. 2. Name of Business, Individual, or Organization 3. Name of Event 4. Event Location 5. Date of Event / Month Street 6. Location Parish City State / 20 Day Year 7. Type of Alcoholic Beverage to be Served Wine Zip Beer Liquor 8. Your Contact Information Name Driver’s License # P. O. Box/Street Cell ph. # City NOTE State Zip State Issued ( ) - Work ph. # ( Home ph. # ( ) - ) - E-mail Address ● IF YOU ARE APPLYING FOR A TYPE A OR TYPE B PERMIT, STOP HERE. PROCEED TO #15. ● TYPE C APPLICANTS MUST COMPLETE THE REMAINDER OF THIS APPLICATION. 9. Do you or your spouse own or hold interest in any business that holds a State retail beer or liquor permit? Yes No ● If YES, enter Permit Number, Trade Name, and Location of Business below: ● Permit # ● Trade Name ● Business Location P.O Box/Street City State Zip American LegalNet, Inc. www.FormsWorkFlow.com 10. Do you own the premises? Yes No ● If NO, a copy of a valid, signed ,and dated lease or written permission from the property owner is required. 11. Are you a citizen of the United States? Yes No ● If NO, enter Naturalization # 12. Have you or your spouse ever been convicted of a felony? Yes No ● If YES, a copy of the Pardon or Restoration of Rights must be attached to this application. 13. Have you or your spouse ever had an alcoholic beverage permit revoked or been convicted of violating any liquor or beer regulatory sta or rule? Yes No ● If YES, please explain below. Explanation, if applicable: 14. Have you or your spouse ever been convicted of soliciting for prostitution, pandering, letting premises for prostitution, contributing to the delinquency of a juvenile, keeping a disorderly place, or dealing in narcotics? Yes No ● If YES, please explain below. Explanation, if applicable: 15. Is this application being made by you to permit any person other than the applicant listed in #2 to secure a beer/liquor permit in your name for his/her benefit? Yes No ● If YES, please explain below. 16. Does applicant, applicant’s spouse, and/or applicant’s membership hold an interest in a business that holds a wholesale or manufacturer beer or liquor permit? Yes No ● If YES, please explain below. Explanation, if applicable: PERMIT FEE 17. Please check the appropriate amount enclosed with this application: ● 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 $ 0 – Type A (Tax-Exempt - IRS documentation required) $ 10 – Type B (Non-Profit - Written proof of status required) $100 – Type C (All Other Individuals and Organizations) ● 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 By signing below, you are swearing, under oath, that you have read each of the questions in this application packet, and that all answers are true and correct to the best of your knowledge; that you meet the qualifications and conditions of R.S. 26:80 and 280 and R.S. 26:85 and 273; that you have no pending application for this location; and that you are not using this special event permit in place of a bona fide license Title: Signature: Print your name: ______________________________________________________ Sworn to and subscribed before me this in the Parish of Signature: day of _________________________________ ,20 State of _______________________________ print name of notary public: American LegalNet, Inc. www.FormsWorkFlow.com