F-1 Permit Application Form. This is a Ohio form and can be use in Department Of Commerce Statewide.
Tags: F-1 Permit Application, DLC 4145, Ohio Statewide, Department Of Commerce
Ohio Department of Commerce - Division of Liquor Control 6606 Tussing Road, P.O. Box 4005 Reynoldsburg, Ohio 43068-9005 Telephone No. (614) 644-3155 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, TYPE OR PRINT PLAINLY 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. ALL QUESTIONS MUST BE ANSWERED SECTION (A): Full Name of Non-Profit Organization Address of Organization City State Zip Code OHIO Name and Address of Convention Facility where Function will be held Street Address List President or Chief Executive Officer of Organization: Township (if outside city or village limits) City Zip Code Name: Area Code - Telephone Number (where officer may be contacted between 8:00 a.m. - 4:30 p.m.): Date and Time Function Will Begin: Mail Permit & Correspondence To: Date and Time Function Will End: Name: Address: Phone: FOR OFFICE USE ONLY Reviewer Action: DLC 4145 Remarks: Rev. 8-05 American LegalNet, Inc. www.FormsWorkflow.com SECTION (B): 1. What municipal corporation or county owns or leases the convention facility? _________________________________________ 2. Is the facility currently used for conventions, public meetings, and exhibitions? _______________________________________ 3. Is applicant a non-profit organization? 4. IF YES, as a non-profit organization, applicant is: 5. Do members of your organization reside in two or more states? YES NO 6. Is your organization's total membership in excess of 500 persons? YES NO YES Unincorporated Association NO Non-Profit Corporation SECTION (C): NOTIFICATION OF CHIEF PEACE OFFICER - This portion must be completed by the Chief Peace Officer in the municipality or the 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) SECTION (D): ___________________________ (Title) (Date) 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, according to law, deposes and says that he is (Print name of President or Chief Executive Officer) President or Chief Executive Officer of _______________________________________________________________________________ (Name of Organization, etc) a non-profit organization with more than 500 members residing in two or more states; that applicant will make no charge for alcoholic beverages in connection with its use of the Convention facility; and that the statements and answers made in the foregoing application are true. ___________________________________________________________________________________________________________ (Signature of Officer) NOTE: DELIBERATE FALSIFICATION OF ANY OF THE INFORMATION ON THIS APPLICATION CAN RESULT IN THE DIVISION'S REFUSING TO ISSUE THE PERMIT. TO BE COMPLETED BY NOTARY PUBLIC: Sworn to before me and subscribed in my presence this ________ day of _______________________, __________. _________________________________________ Notary Public Notary Expiration American LegalNet, Inc. www.FormsWorkflow.com