Page 1 of 3 Form NE-FB (03/2018) ** Renew O nline at https://online.tabc.texas.gov ** APPLICATION FOR TWO-YEAR RENEWAL OF PRIVATE CLUB EXEMPTION CERTIFICATE PERMIT (NE) WITH A FOOD AND BEVERAGE CERTIFICATE (FB) F ORM NE - FB (03/2018) L ICENSE /P ERMIT N UMBER : E XPI RES : CAREFULLY READ ALL INSTRUCTIONS 1. Mailing Address: 2. Trade Name: 3. Location Address: 4. Mailing Address: 5. Business Owner/Applicant (Name of license/permit entity or individual owner filing renewal application) This does not represent the entire business entity structure on file with the Texas Alcoholic Beverage Commission. The licen se/permi t holder is responsible for notifying TABC of any organizational changes at any level of your business structure. Failure to do so may r esult in the cancellation of your license/permit. QUALIFICATIONS 6. Is this application being made by you for the ben efit of someone else? If 223YES,224 indicate below or attach explanation. 6. YES NO 7. Has the applicant, applicant222s spouse, partner, officer, director or stockholders, of the licensed entity become disqualified by law or by facts and conditions from holding a license or permit under the Texas Alcoholic Beverage Code? If 223YES,224 indicate below or attach explanation. 7. YES NO 8. Have there been changes since your original application that have not been reported on this or previous applications? If 223YES,224 indicate below or attach explanation. 8. YES NO LICENSE/PERMIT NUMBER ISSUE DATE TWO - YEAR FEE TWO - YEAR SURCHARGE LATE FEE TOTAL FEES DUE / / BOND INFORMATION REGISTRY NO. American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 3 Form NE-FB (03/2018) LICENSE/PERMIT NUMBER: F ORM NE - FB 9 . Provide last 12 months of sales data. Alcoholic Beverage Sales: $ Other Sales: $ Food Sales: $ Total Sales: $ 10 . Do you maintain food service at this location? 10. YES NO 11 . Are the hours of operation for the sale and service of food and alcoholic beverages the same? 11 . YES NO NOTE: If you DO NOT renew your FOOD AND BEVERAGE CERTIFICATE (FB) you will be required to complete a Publisher222s Affidavit as per Sec. 11.39. The Publisher222s Affidavit and original notice must accompany this renewal. IMPORTANT: Sec. 28.081. SUBSTITUTION OF BRAND WITHOUT CONSENT OF CONSUMER PROHIBITED. (a) The holder of a mixed beverage permit or a private club permit, or the agent, servant or employee of a holder of a mixed beverage permit or private club permit commits an offense if the holder, agent, servant, or employee substitutes one brand of alcoholic beverage for a brand that has been specifically requested by a consumer, unless the consumer is notified and consents to the substitution. (b) A holder of a permit who violates Subsection (a) of this section is liable in a civil suit to a consumer for damages resulting from the substitution. The court shall award the prevailing party in an action under this section attorney222s fees and costs of action. APPLICANT CONTACT IN FORMATION Business Phone # Alternate Phone # Cell Phone # (optional) E-mail (optional) WARNING: Sec. 101.69 of the Texas Alcoholic Beverage Code is as follows: 223205a person who makes a false statement or false representation in an application for a permit or license or in a statement, report, or other instrument to be filed with the Commission and required to be sworn commits an offense punishable by imprisonment in the Texas Department of Criminal Justice for not less than 2 nor more than 10 years.224 ACKNOWLEDGMENT PRINT NAME HERE APPLICANT: PRINT NAME SIGN HERE APPLICANT: SIGN NAME AS SHOWN ABOVE SIGN HERE NOTARY PUBLIC Before me, the undersigned authority, on this day of , 20 the person whose name is signed to the foregoing application personally appeared and, duly sworn by me, states under oath that he or she has read the said application and that all the facts therein set forth are true and correct. SEAL American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 3 Form NE-FB (03/2018) ALL RENEWAL INSTRUCTIONS RENEW online at https://online.tabc.texas.gov and login to your existing account or click the 223Registration224 link. Payments can be made by credit card or electronic transfer (ACH). Do not submit application by mail if you renew online. RENEW by mail: Verify information shown in 1 through 5 for accuracy. Tradename and mailing address changes can be made directly on this form by marking through the incorrect information and entering the current information. Any other changes will require additional forms. Contact your local TABC office or the Licensing Division at 512-206-3360. Sign this application before a notary public. Retain a copy of this renewal for your records. STATE FEES AND SURCHARGES are printed on the front page. Please add your fees and surcharges together for the total amount due. PAYMENTS: Must be paid with a cashier's check, money order or company check payable to the Comptroller of Public Accounts. Personal checks will not be accepted. The postmark date will serve as proof of timely filing. MAIL your renewal, bond if required, and total amount due to: TABC PO Box 13127 Austin TX 78711-3127 NOTE: Bonds may only be required for retail and manufacturer licenses/permits. LATE FILINGS: If you do not file this application before your expiration date, your license/permit will expire and you must cease operations. Your renewal may be filed within 30 calendar days after your expiration date. A $100 late fee will be required for each license/permit, in addition to all fees and surcharges. OTHER FEES: Please note additional fees may be due to your city/county. It is your responsibility to contact these authorities to determine what amounts, if any, may be due and pay those fees. Failure to pay fees due to the city/county may result in administrative action against your license/permit by the commission. For forms and additional information visit us at: www.tabc.texas.gov American LegalNet, Inc. www.FormsWorkFlow.com