LIQUOR LICENSE APPLICATION FORM INSTRUCTIONS License Types x x Check the box for the license or licenses for which you are applying. If your license type is not listed check the “other” box and write in the name of your license. License Actions x x x x x Change Ownership: means you are applying for a liquor license at a business that has the same type of liquor license for which you are applying and the liquor license is current (not expired). New Outlet: means you are applying for a liquor license at a location that currently doesn’t have a liquor license. Greater Privilege: means you already have a Limited On-Premises Sales liquor license at a business and you want to give up that liquor license and get a Full On-Premises Sales liquor license. Additional Privilege: means you already have a liquor license at a business and want to add another liquor license at that business. Other. The most common actions are: o Addition of Partner: means you are adding a person or legal entity as a license applicant o Change of Location: means you are moving your existing business and the same liquor license to a different location o Second or Third Location: a Brewery-Public House licensee is allowed to apply for a second location; a Winery licensee and Grower Sales Privilege licensee may apply for a third location Entity or Individuals applying for the license x x x Any person or legal entity (like a corporation or limited liability company) that will own or control the business must be listed as an applicant. This includes a person or legal entity that will: o Receive profits from the business o Occupy the real property (either as an owner or tenant) o Have control over the personal property o Provide food service o Manage or operate any part of the licensed premises other than as an employee If you are applying as a legal entity the name of the legal entity will be the applicant. If you are not applying as a legal entity then your name should be listed as the applicant. Trade Name x This is the name you will call the business (the name customers will see). LA Instructions – page 1 of 2 (08/11) Business Location x This is the street address of the location that will have the liquor license. Business Mailing Address x If you don’t want the OLCC to send you mail to your business location address, this is where the OLCC will send your mail. Business Numbers x x If you have phone and/or fax number for the business list it here; or If you don’t have a phone and/or fax number for the business leave this section blank. Is the business at this location currently licensed by the OLCC x If you are taking over a business where alcohol is made, sold, or served the current owner should be able to tell you the type of liquor license at that location. Will you have a manager? x x A manager is a person who is not an applicant or licensee; however this is a person who has decision-making authority and whose primary duties include controlling the operation of the licensed premises and its agents regarding the sale and service of alcohol. [This definition may apply to more than one person.] If you will have a manager as described above, you must include a completed OLCC Individual History form for this person with your application. What is the local governing body where your business is located? x x The local government is the local city if your business address is within the city’s limits; or The local government is the local county if your business address is outside the city’s limits. Contact person for this application x This is the person the OLCC can contact. Applicant Signature(s) x x x Each individual person listed in the “Entity or Individuals applying for the license” section must sign the application. If an applicant in the “Entity or Individuals applying for the license” section is a legal entity only one person who is authorized to sign for the legal entity need sign the application. A person with the authority to sign on behalf of the applicant (such as an attorney or a person with power of attorney) may sign the application. Note that the OLCC will likely require proof of such authority. LA Instructions – page 2 of 2 (08/11) OREGON LIQUOR CONTROL COMMISSION LIQUOR LICENSE APPLICATION Application is being made for: CITY AND COUNTY USE ONLY LICENSE TYPES Full On-Premises Sales ($402.60/yr) Commercial Establishment Caterer Passenger Carrier Other Public Location Private Club Limited On-Premises Sales ($202.60/yr) Off-Premises Sales ($100/yr) with Fuel Pumps Brewery Public House ($252.60) Winery ($250/yr) Other:_____________________ ACTIONS Change Ownership New Outlet Greater Privilege Additional Privilege Other __________ The City Council or County Commission: ___________________________________ (name of city or county) recommends that this license be: Granted Denied By:________________________________ (signature) (date) Name:_____________________________ Title:_______________________________ 90-DAY AUTHORITY Check here if you are applying for a change of ownership at a business that has a current liquor license, or if you are applying for an Off-Premises Sales license and are requesting a 90-Day Temporary Authority APPLYING AS: Limited Partnership Date application received: ______________ OLCC USE ONLY Application Rec’d by:___________ ________ Date:______________ Corporation Limited Liability Company Individuals 90-day authority: Yes No 1. Entity or Individuals applying for the license: [See SECTION 1 of the Guide] Œ _________________________________________ z_________________________________________ _ y _________________________________________ {_________________________________________ _ 2. Trade Name (dba):_____________________________________________________________________________ __ 3. Business Location:______________________________________________________________________________ (number, street, rural route) (city) (county) (state) (ZIP code) 4. Business Mailing Address:________________________________________________________________________ (PO box, number, street, rural route) (city) (state) (ZIP code) 5. Business Numbers:______________________________________________________________________________ (phone) (fax) 6. Is the business at this location currently licensed by OLCC? Yes No 7. If yes to whom:__________________________________Type of License:_________________________________ __ 8. Former Business Name:__________________________________________________________________________ 9. Will you have a manager? Yes No Name:_______________________________________________ _ (manager must fill out an Individual History form) 10. What is the local governing body where your business is located?____________________________________ (name of city or county) 11. Contact person for this application:___________________________________________________________ (name) (phone number(s)) __________________________________________________________________________________ __ (address) (fax number) (e-mail address) I understand that if my answers are not true and complete, the OLCC may deny my license application. Applicant(s) Signature(s) and Date: Œ______________________________ Date_________ z___________________________ Date________ y______________________________ Date_________ {____________________________Date_______ 1-800-452-OLCC (6522) www.oregon.gov/olcc (rev. 08/2011)