F Permit Application Form. This is a Ohio form and can be use in Department Of Commerce Statewide.
Tags: F Permit Application, DLC 4115, Ohio Statewide, Department Of Commerce
OHIO DEPARTMENT OF COMMERCE, DIVISION OF LIQUOR CONTROL 6606 TUSSING ROAD REYNOLDSBURG, OHIO 43068-9005 Telephone No. (614) 644-2453 http://www.com.ohio.gov/liqr F PERMIT APPLICATION FILING FEE $40.00 Five-Day Privilege for Special Functions - Valid for the Sale of BEER ONLY, Until 1:00 a.m. APPLICATION MUST BE FILED AT LEAST THIRTY (30) DAYS PRIOR TO THE DATE OF FUNCTION § 4303.20 F permit. Permit F may be issued to an association of ten or more persons, a labor union, or a charitable organization, or to an employer of ten or more persons sponsoring a function for the employer's employees, to purchase from the holders of A-1 and B-1 permits and to sell beer for a period lasting not to exceed five days. No more than two such permits may be issued to the same applicant in any thirty-day period. The special function for which the permit is issued shall include a social, recreational, benevolent, charitable, fraternal, political, patriotic, or athletic purpose but shall not include any function the proceeds of which are for the profit or gain of any individual. The fee for this permit is forty dollars. CAREFULLY READ THE GENERAL INSTRUCTIONS FOR FILING AN F APPLICATION - ON PAGE 5 TYPE OR PRINT PLAINLY ALL QUESTIONS MUST BE ANSWERED Full Name of Organization Street Address Where Function Will Be Held (BE SPECIFIC - and make this address uniform on all documents submitted) Township (Only if outside city or village limits) Zip Code State City County: OHIO Mail and/or Fax Permit and Correspondence To: Name: State: Street Address: Zip Code: Individual responsible for the compliance with Ohio's liquor laws in conjunction with the sale and consumption of alcoholic beverages: City: Phone #: Fax #: Name: Title: Phone #: Date and Time Function Will Begin: Date Function Begins: Time Function Begins: Date and Time Function Will End: Date Function Ends: Time Function Ends: am pm am pm Please check what type of organization: Association of ten or more persons Charitable Organization Employer of ten or more persons sponsoring a function for his employees, except for a manufacturer or wholesale distributor of alcoholic beverages (not open to the public) Labor Union The Division of Liquor Control does not regulate or advise individuals regarding gambling in conjunction with the issuance of an F permit. Any question regarding gambling should be directed to the Ohio Attorney General's Office, Charitable Gaming Section, 150 East Gay Street, 23rd Floor, Columbus, OH 43215 at (614) 466-3181. ANSWER ALL QUESTIONS ON PAGE TWO FOR OFFICE USE ONLY Taxing District Remarks: Reviewer Action: Permit Number Receipt # DLC 4115 Rev. 4-09 American LegalNet, Inc. www.FormsWorkFlow.com 1. What is the purpose of the function? ( Note: The proceeds of the function shall not be used for the profit or gain of any individuals) _____________________________________________________________________________________________ 2. Will the applicant receive 100% of the proceeds of the function? If NO, please explain: ________________________________________________________________________________________________________ YES NO YES NO YES NO YES NO (NOTE: The proceeds of the function shall not be used for the profit or gain of any individuals). 3. Will any individual or for profit association, corporation, or other legal entity receive any financial profit or gain from the event for which you are requesting the F permit? If YES, please explain, including identity and share of each person to receive profit or gain: ________________________________________________________________________________________________________ 4. Will the members of the applicant organization coordinate and operate the event and conduct the sale of alcoholic beverages? If NO, please submit a detailed explanation of the non member involvement and their financial compensation. 5. 6. Will any for profit association, corporation, or other legal entity be involved in the event for which you are requesting the F permit? If YES, please explain: ___________________________________________________________________________________ _______________________________________________________________________________________________________ Give the name and address of the brewer or distributor from whom beer will be purchased. _____________________________________________________________________________________________ _____________________________________________________________________________________________ The Division of Liquor Control does not regulate or advise individuals regarding gambling in conjunction with the issuance of an F permit. Any question regarding gambling should be directed to the Ohio Attorney General's Office, Charitable Gaming Section, 150 East Gay Street, 23rd Floor, Columbus, OH 43215 at (614) 466-3181. THE FOLLOWING MUST BE COMPLETED BY THE APPLICANT(S): STATE OF OHIO, __________________________________COUNTY, ss I/We _________________________________________________________being first duly sworn, according to law, depose and say that the statements and answers made in the foregoing application are true, and say that I/We are at least twenty-one years of age and the statements and answers made in the foregoing application are true. I hereby acknowledge that I/We are required by law to be responsible for any conduct that violates laws pertaining to the sale of alcoholic beverages. FALSIFICATION OF ANY OF THE INFORMATION ON THIS APPLICATION CAN RESULT IN THE DIVISION'S REFUSING TO ISSUE THIS PERMIT. _____________________________________________________ _____________________ (Signatures of Officer of Association, Lodge or Corporation) (Title) __________________________________________ (Print Name) ________________________________________________ ___________________________ _______ _________________ _____________________________ (Residence Address) (City) (State) (Zip Code) (Telephone Number) (This portion to be completed by Notary Public) Sworn to before me and subscribed in my presence this ______________day of _______________________________________. _____________________________________________________ (Notary Public) (Notary Expiration) _____________________________________________________ (Notary - Please Print Name or Affix Seal/Stamp) EOE/ADA SERVICE PROVIDER Page 2 FOR TTY USERS DIAL ORS 1-800-750-0750 American LegalNet, Inc. www.FormsWorkFlow.com OHIO DEPARTMENT OF COMMERCE DIVISION OF LIQUOR CONTROL 6606 Tussing Road, P.O. Box 4005, Reynoldsburg, Ohio 43068-9005 TENANCY & POLICE NOTIFICATION FORM FOR A TEMPORARY "F" APPLICATION Section A. (Completed by Applicant): TEMPORARY PERMIT FUNCTION INFORMATION The _________________________________________________________________________________________________________________ (Full Name of Organization [this must be same as what is listed on Application]) will be conducting an event at the location of__________________________________________________________________________________, (Location or Street address where function held [this must be same as what is listed on Application]) and has appled for an "F" class temporary liquor permit to allow the sale of beer: beginning ____________________________________ at (Date Function Begins) am pm am pm (Time Function Begins) and ending ____________________________________ at (Date Function Ends) (Time Function Ends) Section B. (Completed by Property Owner): CONSENT OF REAL PROPERTY OWNER INFORMATION If applicant is owner of real property mark box, and sign below. I/We, being the owner of the realty located at the address mentioned in Section A. above, do hereby acknowledge notification that the Organization listed above will hold a special function on the dates specified by signing below. X____________________________________________________________ _________________________________________________ _________________ (Date) (Print Name of Real Property Owner) (Signed - Real Property Owner) _______________________________________________________________________________________________________________________________ (Telephone Number) (City, State, and Zip Code (Street Address of Real Property Owner) Section C. (Completed by Chief Peace Officer): NOTICE TO CHIEF PEACE OFFICER (City/Township Police, OR County Sheriff) This portion must be signed 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 accordingly.) I, being the Chief Peace Officer of the City, Township or County where the function listed above in Section A will be held, acknowledges that I have received notification that the Organization listed above will hold a special function on the dates specified, by signing below. City Police Twp Police County Sheriff X_________________________________________________________________________________________________________________________________ (Signed) (Title) (Check the box that applies) (Date) __________________________________________________________________ (Print Name) In signing this form, the Chief Peace Officer is merely acknowledging receipt of notification of the event and not giving their approval or consent of the event on behalf of the political subdivision. DLC 4221 EOE/ADA SERVICE PROVIDER Page 3 FOR TTY USERS DIAL ORS 1-800-750-0750 American LegalNet, Inc. www.FormsWorkFlow.com DIAGRAM OF PERMIT PREMISES FOR TEMPORARY "F" OR "F-2" PERMIT THIS DOCUMENT MUST BE COMPLETED IN ORDER TO OBTAIN YOUR TEMPORARY PERMIT Section 4301.62 ("open container statute") prohibits anyone from possessing an open container of any alcoholic beverage outside of the area defined as permit premises. Whoever violates this statute is guilty of a MISDEMEANOR. Any alcoholic beverage must be both sold and consumed within the defined permit premises. It is now required that every applicant for an F or F2 permit submit with the application a diagram of the premises where alcoholic beverages will be sold and 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 should be signed by the person who prepared the diagram or the applicant themselves. FOR EVENTS HELD INDOORS: Diagram must identify the room(s) and/or building in which the alcoholic beverages will be sold and consumed. FOR EVENTS HELD ENTIRELY or PARTIALLY OUTDOORS: Diagram must show shape and measured dimensions of the area to be used. Location of barriers must be shown, and an explanation of the type of barriers given (e.g. chain link fence, snow fence, brick wall, rope, etc.) which will separate permit premises from other areas which are not permit premises. DIAGRAM MUST APPEAR IN THE SPACE BELOW Signature of Person who prepared diagram or applicant Page 4 American LegalNet, Inc. www.FormsWorkFlow.com GENERAL INSTRUCTIONS FOR FILING "F" APPLICATIONS The "F" permit may be issued to any association of ten or more persons, labor union, charitable organization, or to an employer of ten or more persons sponsoring a function for his employees to sell beer only. An "F" permit is effective for not more than five (5) days for the sale of beer only until 1:00 a.m. No more than two (2) "F" permits may be issued to the same applicant in any thirty (30) day period. APPLICATION WILL NOT BE ACCEPTED WITHOUT THE FOLLOWING REQUIRED DOCUMENTS 1. Forty ($40.00) dollar filing fee. Make check payable to the Division of Liquor Control. Please do not mail cash. 2. Letter of approval from Fair Board if function is to be held on county fairgrounds. 3. Division of Liquor Control Form 4221, Consent of Real Property Owner/Notification of Chief Peace Officer. 4. Copy of diagram of permit premises, (Form DLC 4221) denoting areas where beer will be consumed. 5. If the event is on the premises of a retail permit holder you must submit a notarized affidavit, signed by an officer/owner of the retail permit, stating they will not utilize their permit privileges at the same time and place as the temporary event. WARNINGS Applicant must be at least twenty-one (21) years of age. Section 4301.24 of Ohio Revised Code prohibits any manufacturer or wholesale distributor from aiding or assisting any retail permit holder by gift or loan of any money or property of any description or other valuable thing; and it prohibits any retail permit holder from accepting same. THIS MEANS A WHOLESALE DISTRIBUTOR MAY NOT AID THE PERMIT HOLDER IN ANY WAY, EITHER FINANCIALLY OR BY ADVERTISING THE FUNCTION COVERED BY THIS APPLICATION; AND THE PERMIT HOLDER MAY NOT ACCEPT SUCH ASSISTANCE FROM THE WHOLESALE DISTRIBUTOR. An "F" permit holder must purchase all alcoholic beverages from a wholesale distributor. It is illegal to allow a patron to remove any alcoholic beverage from or to consume it off the premises designated on your permit. It is illegal for any person under the age of twenty-one (21) to purchase or consume alcoholic beverages. It is the permit holder's responsibility to obtain proper identification. Page 5 American LegalNet, Inc. www.FormsWorkFlow.com