6606 Tussing Road, P.O. Box 4005, Reynoldsburg, Ohio 43068-9005 Telephone No. (614) 387-7407 - http://www.com.ohio.gov/liqr Ohio Department of Commerce - Division of Liquor Control F-5 PERMIT APPLICATION FILING FEE $180.00 APPLICATION MUST BE FILED AT LEAST THIRTY (30) DAYS PRIOR TO THE DATE OF FUNCTION. Ohio Revised Code 4303.205 F5 Permit (A)(1) "Festival" means an event organized by a nonprofit organization that includes food, music, and entertainment and the participation of at least five riverboats. (A)(2) "Nonprofit organization" has the same meaning as in section 4303.201 of the Revised Code. (B) The division of liquor control may issue an F-5 permit to the owner or operator of a riverboat that has a capacity in excess of fifty-five persons, that is not regularly docked in this state, and whose owner or operator has entered into a written contract with a nonprofit organization for the riverboat to participate in a festival. (C) The holder of an F-5 permit may sell beer and any intoxicating liquor, only by the individual drink in glass and from the container, for consumption on the premises where sold until one a.m., on any day of the week, including Sunday. (D) The division shall prepare and make available an F-5 permit application form and may require applicants for the permit to provide information, in addition to that required by this section, that is necessary for the administration of this section. (E) Sales under an F-5 permit are not affected by whether sales of beer or intoxicating liquor for consumption on the premises where sold are permitted to be made by persons holding another type of permit in the precinct or at the particular location where the riverboat is located. (F) No F-5 permit shall be in effect for more than six consecutive days. (G) The division shall not issue more than one F-5 permit in any one calendar year for the same riverboat. (H) The fee for an F-5 permit is one hundred eighty dollars. SECTION (A) Riverboat Owner/ Operator: Name of Festival: PROPOSED F-5 PERMIT PREMISES INFORMATION Name of Riverboat: Festival Street Address: Township (if outside city limits): Mail and/or Fax Permit and Correspondence To: Name: State: Zip Code: Street Address: Phone #: Name: Title: Time Function Begins: Time Function Ends: FOR OFFICE USE ONLY Taxing District Permit Number Receipt # DLC4256 Page 1 Rev.1-07 American LegalNet, Inc. www.FormsWorkFlow.com City: Zip Code: County: City: Fax #: Individual responsible for the compliance with Ohio's liquor laws in conjunction with the sale and consumption of alcoholic beverages: Date and Time Date Function Begins: Function Will Begin: Date and Time Function Will End: Date Function Ends: am am pm pm Reviewer Action: Remarks: SECTION (B) 1. 2. OWNER/APPLICANT INFORMATION What is the capacity of people the riverboat may transport? Is the riverboat regularly docked in Ohio? If YES, please indicate where: YES NO 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. I, ___________________________________________ the Chief Peace officer of ___________________________________ (Name) (Full Name of Organization) (City, Township or County) do hereby acknowledge notification that ___________________________________ will hold a special function at which alcoholic beverages will be sold on ________________________________ between the hours of __________ am/pm and ________________ (Date) (Time) (Time) at __________________________________________________________________________________________________ (Street Address Will Function Will Be Held) (Title) ________________________________________ (Signed) _______________________________ ___________________ (Date) (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). TO ENSURE THAT THIS APPLICATION IS PROCESSED AS QUICKLY AS POSSIBLE, PLEASE SUBMIT THE FOLLOWING, ALONG WITH THIS COMPLETED, SIGNED, AND NOTARIZED APPLICATION $180.00 Permit Fee - Check made payable to the Division of Liquor Control. Completed and signed "Diagram of the Riverboat indicating areas to be covered by F5 permit, and any attachments. Diagram may be submitted on Page 3 of this application. Copy of current Certificate of Inspection issued by the United States Coast Guard Copy of written contract that the applicant holds with the non profit organization to participate in the festival. Sections A, B, & C Completed. State of Ohio, I, County, ss being first duly sworn, according to law, depose and say that the statements (Please Print) and answers made in the foregoing application are true. ___________________________________________________________________________ (Signature of Officer of Applicant) _____________________ (Title) _______________ (Date) (Residence Address) (To be completed by Notary Public) (City) (State) (Zip Code) (Area Code & Telephone Number) Sworn to before me and subscribed in my presence this ______________day of _____________________________________, 20 _____________. ________________________________________ (Notary Public) _______________ (Notary Expiration) EOE/ADA SERVICE PROVIDER Page 2 FOR TTY USERS DIAL ORS 1-800-750-0750 American LegalNet, Inc. www.FormsWorkFlow.com SECTION (D) - DIAGRAM OF PROPOSED PERMIT PREMISES FOR "F-5" RIVERBOAT LIQUOR PERMIT THIS DOCUMENT MUST BE COMPLETED IN ORDER TO OBTAIN YOUR TEMPORARY PERMIT Every applicant for an F-5 liquor permit must submit with the application a diagram of the riverboat indicating the area(s) on the riverboat where alcoholic beverages will be consumed. If the diagram is not included, the application will be returned to the applicant. The diagram can be submitted in the space provided below or on a separate sheet and signed by person who prepared the diagram or the applicant. The diagram must identify the room(s) in which alcoholic beverages will be consumed. DIAGRAM MUST APPEAR IN THE SPACE BELOW, OR ON ATTACHED SHEET _________________________________________________________ Signature of person who prepared diagram _____________________________________________________________________ Print