BUREAU USE ONLY Department of Public Safety Liquor Licensing & Inspection Division License No. Assigned: Class: Deposit Date: Promise by any person that he or she can expedite a liquor license through influence should be completely disregarded. To avoid possible financial loss an applicant, or prospective applicant, should consult with the Division before making any substantial investment in an establishment that now is, or may be, attended by a liquor license. INDICATE TYPE OF PRIVILEGE: ‫ڤ‬ ‫ڤ‬ ‫ڤ‬ ‫ڤ‬ ‫ڤ‬ Amt. Deposited: PRESENT LICENSE EXPIRES ________________ ‫ ڤ‬MALT ‫ ڤ‬SPIRITUOUS ‫ ڤ‬VINOUS INDICATE TYPE OF LICENSE: RESTAURANT (Class I,II,III,IV) ‫ ڤ‬RESTAURANT/LOUNGE (Class XI) HOTEL-OPTINONAL FOOD (Class I-A) ‫ ڤ‬HOTEL (Class I,II,III,IV) CLASS A LOUNGE (Class X) ‫ ڤ‬CLUB-ON PREMISE CATERING (Class I) CLUB (Class V) ‫ ڤ‬GOLF CLUB (Class I,II,III,IV) TAVERN (Class IV) ‫ ڤ‬OTHER: _______________________________ REFER TO PAGE 3 FOR FEE SCHEDULE ALL QUESTIONS MUST BE ANSWERED IN FULL 1. APPLICANT(S) –(Sole Proprietor, Corporation, Limited Liability Co., 2. Business Name (D/B/A) etc.) DOB: DOB: Location (Street Address) DOB: Address City/Town State Zip Code State Zip Code Mailing Address City/Town State Telephone Number Zip Code Fax Number Federal I.D. # City/Town Business Telephone Number Fax Number Seller Certificate # 3. If premises is a hotel, indicate number of rooms available for transient guests: ________ 4. State amount of gross income from period of last license: ROOMS $ _______ FOOD $ _______ LIQUOR $_______ 5. Is applicant a corporation, limited liability company or limited partnership? YES ‫ڤ‬ NO ‫ڤ‬ If YES, complete Supplementary Questionnaire 6. Do you permit dancing or entertainment on the licensed premises? YES ‫ڤ‬ NO ‫ڤ‬ 7. If manager is to be employed, give name: _____________________________________________________________ 8. If business is NEW or under new ownership, indicate starting date: __________________ Requested inspection date: ___________________ Business hours: _______________ 9. Business records are located at: _____________________________________________________________________ 10. Is/are applicants(s) citizens of the United States? YES ‫ڤ‬ NO ‫ڤ‬ 11. Is/are applicant(s) residents of the State of Maine? YES ‫ڤ‬ NO ‫ڤ‬ 164 State House Station Augusta Me 04333-0164 Tel: 207-624-7220 Fax: 207-287-3424 OnPremiseApp.doc / 2003 American LegalNet, Inc. www.FormsWorkflow.com 12. List name, date of birth, and place of birth for all applicants, managers, and bar managers. Give maiden name, if married: Use a separate sheet of paper if necessary. Name in Full (Print Clearly) DOB Place of Birth Residence address on all of the above for previous 5 years (Limit answer to city & state 13. Has/have applicant(s) or manager ever been convicted of any violation of the law, other then minor traffic violations, of any State of the United States? YES ‫ ڤ‬NO ‫ڤ‬ Name: ______________________________________________ Date of Conviction: _______________________ Offense: ____________________________________________ Location: ________________________________ Disposition: _________________________________________ 14. Will any law enforcement official benefit financially either directly or indirectly in your license, if issued? Yes ‫ ڤ‬No ‫ڤ‬ If Yes, give name: _____________________________________________________________ 15. Has/have applicant(s) formerly held a Maine liquor license? 16. Does/do applicant(s) own the premises? Yes ‫ڤ‬ No ‫ڤ‬ YES ‫ڤ‬ NO ‫ڤ‬ If No give name and address of owner: ______________ ___________________________________________________________________________________________________________________________________ 17. Describe in detail the premises to be licensed: (Supplemental Diagram Required) _____________________________ ___________________________________________________________________________________________________________________________________ 18. Does/do applicant(s) have all the necessary permits required by the State Department of Human Services? YES ‫ ڤ‬NO ‫ ڤ‬Applied for: ______________________ 19. What is the distance from the premises to the NEAREST school, school dormitory, church, chapel or parish house, measured from the main entrance of the premises to the main entrance of the school, school dormitory, church, chapel or parish house by the ordinary course of travel? __________ Which of the above is nearest? __________________ 20. Have you received any assistance financially or otherwise (including any mortgages) from any source other than yourself in the establishment of your business? YES ‫ ڤ‬NO ‫ڤ‬ If YES, give details: _____________________________________________________________________________ The Division of Liquor Licensing & Inspection is hereby authorized to obtain and examine all books, records and tax returns pertaining to the business, for which this liquor license is requested, and also such books, records and returns during the year in which any liquor license is in effect. NOTE: “I understand that false statements made on this form are punishable by law. Knowingly supplying false information on this form is a Class D offense under the Criminal Code, punishable by confinement of up to one year or by monetary fine of up to $2,000 or both.” Dated at: _______________________________________ on _________________________, 20 _____ Town/City, State Date Please sign in blue ink _____________________________________________________ ____________________________________________________ Signature of Applicant or Corporate Officer(s) Signature of Applicant or Corporate Officer(s) ______________________________________ Print Name _____________________________________ Print Name American LegalNet, Inc. www.FormsWorkflow.com NOTICE – SPECIAL ATTENTION All applications for NEW or RENEWAL liquor licenses must contact their Municipal Officials or the County Commissioners in unincorporated places for approval of their application for liquor licenses prior to submitting them to the bureau. THIS APPROVAL EXPIRES IN 60 DAYS. FEE SCHEDULE Class I Spirituous, Vinous and Malt ................................................................................................................ $ 900.00 CLASS I: Airlines; Civic Auditoriums; Class A Restaurants: Clubs with catering privileges; Dining Cars; Golf Clubs; Hotels; Indoor Ice Skating Clubs; Indoor Tennis Clubs; Vessels; Qualified Caterers; OTB. Class I-A Spirituous, Vinous and Malt, Optional Food (Hotels Only) ................................................................ $1,100.00 CLASS I-A: Hotels only that do not serve three meals a day. Class II Spirituous Only .................................................................................................................................... $ 550.00 CLASS II: Airlines; Civic Auditoriums; Class A Restaurants; Clubs with catering privileges; Dining Cars; Golf Clubs; Hotels; Indoor Ice Skating Clubs; Indoor Tennis Clubs; and Vessels. Class III Vinous Only ........................................................................................................................................ $ 220.00 CLASS III: Airlines; Civic Auditoriums; Class A Restaurants; Clubs with catering privileges; Dining Cars; Golf Clubs; Hotels; Indoor Ice Skating Clubs; Indoor Tennis Clubs; Restaurants; Vessels; Pool Halls; and Bed and Breakfasts. Class IV Malt Liquor Only ................................................................................................................................. $ 220.00 CLASS IV: Airlines; Civic Auditoriums; Class A Restaurants; Clubs with catering privileges; Dining Cars; Golf Clubs; Hotels; Indoor Ice Skating Clubs; Indoor Tennis Clubs; Restaurants; Taverns; Pool Halls; and Bed and Breakfasts. Class V Spirituous, Vinous and Malt (Clubs without Catering, Bed & Breakfasts) ......................................... $ 495.00 CLASS V: Clubs without catering privileges. Class X Spirituous, Vinous and Malt – Class A Lounge .................................................................................. $2,200.00 CLASS X: Class A Lounge Class XI Spirituous, Vinous and Malt – Restaurant Lounge .............................................................................. $1,500.00 CLASS XI: Restaurant/Lounge; and OTB. FILING FEE............................................................................................................................................................ $ 10.00 UNORGANIZED TERRITORIES $10.00 filing fee shall be paid directly to County Treasurer. All applicants in unorganized territories shall submit along with their application evidence of payment to the County Treasurer. All fees must accompany application, made payable to: TREASURER, STATE OF MAINE. – DEPARTMENT OF PUBLIC SAFETY, LIQUOR LICENSING AND INSPECTION DIVISION, 164 STATE HOUSE STATION, AUGUSTA ME 04333-0164. Payments by check subject to penalty provided by Sec. 3, Title 28A, MRS. American LegalNet, Inc. www.FormsWorkflow.com STATE OF MAINE Dated at: _____________________________________, Maine _________________________________ ss City/Town (County) On: _________________________________________ Date The undersigned being: ‫ ڤ‬City ‫ ڤ‬Town ‫ ڤ‬Municipal Officers ‫ ڤ‬Plantation ‫ ڤ‬County Commissioners ‫ ڤ‬Unincorporated Place of the of: ___________________________________, Maine Hereby certify that we have given public notice on this application and held public hearing thereon as required by Section 653 Title 28A, Maine Revised Statutes and herby approve said application. ______________________________________________ _______________________________________________ ________________________________________________________ __________________________________________________________ ________________________________________________________ __________________________________________________________ THIS APPROVAL EXPIRERS IN 60 DAYS NOTICE – SPECIAL ATTENTION § 653. Hearings; bureau review; appeal 1. Hearing. The municipal officers or, in the case of unincorporated places, the county commissioners of the county in which the unincorporated place is located, shall hold a public hearing for the consideration of applications for new on-premise licenses and applications for transfer of location of existing on-premise licenses. The municipal officers or county commissioners may hold a public hearing for the consideration of requests for renewal of licenses, except that when an applicant has held a license for the prior 5 years and a complaint has not been filed against the applicant within that time, the applicant may request a waiver of the hearing. A. The bureau shall prepare and supply application forms. [1993, c.730, §27(amd).] B. The municipal officers or the county commissioners, as the case may be, shall provide public notice of any hearing held under this section by causing a notice, at the applicant’s prepaid expense, stating the name and place of hearing, to appear on at least 3 consecutive days before the date of hearing in a daily newspaper having general circulation in the municipality where the premises are located or one week before the date of the hearing in a weekly newspaper having general circulation in the municipality where the premises are located. [1995, c.140, §4 (amd).] C. If the municipal officers or the county commissioners, as the case may be, fail to take final action on an application for a new onpremise license, for transfer of the location of an existing on-premise license or for renewal of an on-premise license within 60 days of the filing of an application, the application is deemed approved and ready for action by the bureau. For purposes of this paragraph, the date of filing of the application is the date the application is received by the municipal officers or county commissioners. This paragraph applies to all applications pending before municipal officers or county commissioners as of the effective date of this paragraph as well as all applications filed on or after the effective date of this paragraph. This paragraph applies to an existing on-premise license that has been extended pending renewal. The municipal officers or the county commissioners shall take final action on an on-premise license that has been extended pending renewal with 120 days of the filing of the application. [1999, c589, §1 (amd).] 2. Findings. In granting or denying an application, the municipal officers or the county commissioners shall indicate the reasons for their decision and provide a copy to the applicant. A license may be denied on one or more of the following grounds: A. Conviction of the applicant of any Class A, Class B or Class c crime: [1987, c45, Pt.A§4 (new).] B. Noncompliance of the licensed premises or its use with any local zoning ordinance or other land use ordinance not directly related to liquor control; [1987, c.45, Pt.A§4(new).] C. Conditions of record such as waste disposal violations, health or safety violation or repeated parking or traffic violations on or in the vicinity of the licensed premises and caused by persons patronizing or employed by the licensed premises or other such conditions caused by persons patronizing or employed by the licensed premises that unreasonably disturb, interfere with or affect the ability of persons or businesses residing or located in the vicinity of the licensed premises to use their property in a reasonable manner; [1993, c.730, §27 (amd).] D. Repeated incidents of record of breaches of the peace, disorderly conduct, vandalism or other violations of law on or in the vicinity of the licensed premises and caused by persons patronizing or employed by the licensed premises; [1989, c.592,§3 (amd).] E. A violation of any provision of this Title; and [1989, c.592, §3 (amd).] F. A determination by the municipal officers or county commissioners that the purpose of the application is to circumvent the provisions of section 601. [1989, c.592, §4 (new).] [1993, c730, §27 (amd).] 3. Appeal to bureau. Any applicant aggrieved by the decision of the municipal officers or county commissioners under this section may appeal to the bureau within 15 days of the receipt of the written decision of the municipal officers or county commissioners. The bureau shall hold a public hearing in the city, town or unincorporated place where the premises are situated. In acting on such an appeal, the bureau may consider all licensure requirements and findings referred to in subsection 2. A. [1993, c.730, §27 (rp).] 4. No license to person who moved to obtain a license. (REPEALED) 5. (TEXT EFFECTIVE 3/15/01) Appeal to District Court. Any person or governmental entity aggrieved by a bureau decision under this section may appeal the decision to the District Court within 30 days of receipt of the written decision of the bureau. An applicant who files an appeal or who has an appeal pending shall pay the annual license fee the applicant would otherwise pay. Upon resolution of the appeal, if an applicant’s license renewal is denied, the bureau shall refund the applicant the prorated amount of the unused license fee. American LegalNet, Inc. www.FormsWorkflow.com