Ohio Department of Commerce - Division of Liquor Control 6606 Tussing Road, P.O. Box 4005 Reynoldsburg, Ohio 43068-9005 Telephone No. (614) 387-7407 http://www.com.ohio.gov/liqr F-1 PERMIT APPLICATION Three-Day Privilege for Special Functions Filing Fee - $250.00 APPLICATION MUST BE FILED AT LEAST THIRTY (30) DAYS PRIOR TO THE DATE OF FUNCTION. Section 4303.201(A) As used in this section: (1) "Convention facility" means any structure owned or leased by a municipal corporation or county which was expressly designed and constructed and is currently used for the purpose of presenting conventions, public meetings, and exhibitions. (2) "Nonprofit organization" means any unincorporated association or nonprofit corporation that is not formed for the pecuniary gain or profit of, and whose net earnings or any part thereof is not distributable to, its members, trustees, officers, or other private persons; provided, that the payment of reasonable compensation for services rendered and the distribution of assets on dissolution shall not be considered pecuniary gain or profit or distribution of earnings. In an association or corporation all of whose members are nonprofit corporations, distribution of earnings to member organizations does not deprive it of the status of a nonprofit organization. (B) An F-1 permit may be issued to any nonprofit organization to allow the nonprofit organization and its members and their guests to lawfully bring beer, wine, and intoxicating liquor in its original package, in flasks, or other containers into a convention facility for consumption therein, if both of the following requirements are met: (1) The Superintendent of liquor control is satisfied the organization meets the definition of a nonprofit organization as set forth in division (A)(2) of this section, the non-profit organization's membership includes persons residing in two or more states, and the organization's total membership is in excess of five hundred. The Superintendent of liquor control may accept a sworn statement by the president or other chief executive officer of the nonprofit organization as proof of the matters required in this division. (2) The managing official or employee of the convention facility has given his written consent to the use of the convention facility and to the application for the F-1 permit, as shown in the nonprofit organization's application to the Superintendent of liquor control.(C) The Superintendent of liquor control shall specify individually the effective period of each F-1 permit on the permit, which shall not exceed three days. The Superintendent of liquor control shall prepare and make available application forms to request F-1 permits and may require applicants to furnish such information as he determines to be necessary for the administration of this section. (D) No holder of an F-1 permit shall make a specific charge for beer, wine, or intoxicating liquor by the drink, or in its original package, flasks, or other containers in connection with its use of the convention facility under the permit. TYPE OR PRINT PLAINLY SECTION (A): Full Name of Non-Profit Organization: Address of Organization: Name of Convention Facility where Function will be held: Address of Convention Facility: City: List President or Chief Executive Officer of Organization: Phone # - (where officer may be contacted between 8:00 a.m. - 4:30 p.m.): Date and Time Function Will Begin: Date and Time Function Will End: Date Function Begins: Date Function Ends: ALL QUESTIONS MUST BE ANSWERED City: State OHIO Zip Code: Township (if outside city limits): Zip Code: Time Function Begins: Time Function Ends: am am City: Fax #: pm pm Mail and/or Fax Permit and Correspondence To: Name: State: Zip Code: Street Address: Phone #: FOR OFFICE USE ONLY Reviewer Action: Remarks: DLC 4145 EOE/ADA SERVICE PROVIDER FOR TTY USERS DIAL ORS 1-800-750-0750 Rev. 4/2012 American LegalNet, Inc. www.FormsWorkFlow.com SECTION (B): 1. What municipal corporation or county owns or leases the convention facility? 2. 3. 4. 5. 6. Is the facility currently used for conventions, public meetings, and exhibitions? Is applicant a non-profit organization? IF YES, as a non-profit organization, applicant is: Do members of your organization reside in two or more states? Is your organization's total membership in excess of 500 persons? Unincorporated Association YES NO Non-Profit Corporation YES YES NO NO SECTION (C): NOTIFICATION OF CHIEF PEACE OFFICER - This portion must be completed by the Chief Peace Officer in the municipality or township where this function will be held indicating that he/she has been notified of the date, time, place and duration of the event. (If the township does not have a Chief Peace Officer, the County Sheriff's Department must be notified. NOTE: (In signing this form, the Chief Peace Officer is merely acknowledging receipt of notification of the event and not giving their approval or consent on behalf of the political subdivision). I, ___________________________________________ the Chief Peace officer of ___________________________________ (Name) (City, Township or County) do hereby acknowledge notification that ___________________________________ will hold a special function at which alcoholic (Full Name of Organization) beverages will be sold on ________________________________ between the hours of __________ am/pm and ____________ (Date) (Time) (Time) at _____________________________________________________________________________________________________ (Street Address Will Function Will Be Held) ________________________________________ _______________________________ (Signed) (Title) ___________________________ (Date) SECTION (D): CONSENT TO F-1 APPLICATION AND USE OF CONVENTION FACILITY I, ____________________________________________, managing official of the _______________________________________ (print name) (please print) _____________________________________________ convention facility hereby give my written consent to the use of the convention facility and to the applicant for the F-1 permit as shown in this application. _________________________________________________________ (Signature and Title of Managing Official of Convention Facility) THE FOLLOWING MUST BE COMPLETED BY THE PRESIDENT OR CHIEF EXECUTIVE OFFICER OF THE NON-PROFIT ORGANIZATION State of Ohio, ______________________________________County, ss _______________________________________________________, being first duly sworn,