Page 1 of 5 Form L-ON (12/2017) ON-PREMISE PREQUALIFICATION PACKET L-ON ( 12 / 20 1 7 ) Submit this packet to the proper governmental entities to obtain certification for the type of license/permit for which you are applying as required by Sections 11.37, 11.39, 11.46(b), 61.37, 61.38, 61.42 and Rule 24733.13 Contact your local TABC office to verify requirements of Sections 11.391 and 61.381 as you may be required to post a sign at your proposed location 60-days prior to the issuance of your license/permit. All statutory and rule references mentioned in this application refer to and can be found in the Texas Alcoholic Beverage Code or Rules located on our website. www.tabc.texas.gov/laws/codeandrules.asp LOCATION INFORMATION 1. Application for: Original Add Late Hours Only License/Permit Number Reinstatement License/Permit Number Change of Licensed Loc ation License/Permit Numbe r 2 . Type of On - Premise License/Permit BG Wine and Beer Retailer222s Permit LB Mixed Beverage Late Hours Permit BE Beer Retail Dealer222s On - Premise License MI Minibar Permit BL Retail Dealer222s On - Premise Late Hours License CB Caterer222s Permit BP Brewpub License FB Food and Beverage Certificate V Wine & Beer R etailer222s Permit for Excursion Boats PE Beverage Cartage Permit Y Wine & Beer Retailer222s Permit for Railway Dining Car RM Mixed Beverage Restaurant Permit with FB MB Mixed Beverage P ermit O Private Carrier222s Permit 226 For Brewpubs (BP) with a BG only 3 . Indicate Primary Business at this Location Restaurant Sporting Arena, Civic Center, Hotel Bar Grocery/Market Sexually Oriented Miscellaneous 4 . Trade Name of Location 5 . Location Address City County State Zip Code 6 . Mailing Address City State Zip Code 7 . Business Phone No. Alternate Phone No. E - mail Addre ss OWNER INFORMATION 8 . Type of Owner Individual Corporation City/County/University Partnership Lim ited Liability Company Other Limited Partnership Joint Venture Limited Liability Partnership Trust 9 . Business Owner /Applicant 10. Are you, the applicant a veteran-owned business? Yes No 11. Are you, the applicant a Historically Underutilized Business (HUB)? Yes No American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 5 Form L-ON (12/2017) 1 2 . As indicated on the chart, enter the individuals that pertain to your business type: (For additional space, use Form L - OIC) Individu al/Individual Owner Limited Liability Company/All Officers or Managers Partnership/All Partners Joint Venture/Venturers Limited Partnership/All General Partners Trust/Trustee(s) Corporation/All Officers City, County, University/Official Last Name Fi rst Name MI Title Last Name First Name MI Title Last Name First Name MI Title MEASUREMENT INFORMATION Section 109.31 et seq. 13. Will your business be located within 300 feet of a church or public hospital? Yes No NOTE: For churches or public hospitals measure from front door to front door, along the property lines of the street fronts and in a direct line across intersections. 14. Will your business be located within 300 feet of any private/public school, day care center or child care facility? Yes No If 223YES,224 are the facilities located on different floors or stories of the building? Yes No NOTE: NOTE: NOTE: For private/public schools, day care centers and child care facilities measure in a direct line from the nearest property line of the school, day care center or child care facility to the nearest property line of the place of business, and in a direct line across intersections. For multistory building: businesses may be within 300 feet of a day care center or child care facility as long as the facilities are located on different floors of the building. If located on or above the fifth story of a multistory building: measure in a direct line from the property line of the private/public school to property line of your place of business in a direct line across intersections vertically up the building at the property line to the base of the floor on which your business is located. 15. Will your business be located within 1,000 feet of a private school? Yes No 16. Will your business be located within 1,000 feet of a public school? Yes No 60-DAY SIGN 17. As required under Section 11.391 and 61.381, enter the exact date the 60- Day sign was posted at your location. Exact Date (MM/DD/YYYY) ALL APPLICANTS 18.IF YOUR LOCATION IS NOT WITHIN THE CITY LIMITS, CHECK HERE I, the applicant, have confirmed I am not located in the city limits of any city and therefore all citycertificates are not required. American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 5 Form L-ON (12/2017) WARNING AND SIGNATURE IF APPLICANT IS SHOWN AS: WHO MUST SIGN: Proprietorship Individual Owner Partnership P artner Corporation Officer Limited Partnership General Partner Limited Liability Partnership General Partner Limited Liability Company Officer/Manager WARNING : Section 101.69 of the Texas Alcoholic Beverage Code states: 223205a person who makes a fal se 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 I, UNDER PENALTY OF LAW, HEREBY SWEAR THAT I HAVE READ ALL THE INFORMATION PROVIDED IN THE APPLICATION AND ANY ATTACHMENTS AND THE INFORMATION IS TRUE AND CORRECT. I ALSO UNDERSTAND ANY FALSE STATEMENT OR REPRESENTATION IN THIS APPLICATION CAN RESULT IN MY APPLICATION BEING DENIED AND/OR CRIMINAL CHARGES FILED AGAINST ME. I ALSO AUTHORIZE THE TEXAS ALCOHOLIC BEVERAGE COMMISSION TO USE ALL LEGAL MEANS TO VERIFY THE INFORMATION PROVIDED. PRINT NAME SIGN HERE TITLE 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. SIGN HERE NOTARY PUBLICS E A L CERTIFICATE OF CITY SECRETARY ( FOR MB, RM, V & Y ) Section 11.37 I hereby certify on this day of , 20 , that the location for which the license/permit is sought is inside the boundaries of this city or town, in a 223wet224 area for such license/permit, and not prohibited by charter or ordinance in reference to the sale of such alcoholic beverages. SIGN HERE , TEXAS City Secretary/Clerk City S E A L CERTIFICATE OF CITY SECRETARY (FOR BG & BE) Section 11.37 & 61.37 I hereby certify on this day of , 20 , that the location for which the license/permit is sought is inside the boundaries of this city or town, in a 223wet224 area for such license/permit, and not prohibited by charter or ordinance in reference to the sale of such alcoholic beverages. Election for given location was held for: legal sale of all alcoholic beverages legal sale of all alcoholic beverages except mixed beverages legal sale of all alcoholic beverages including mixed beverages legal sale of beer/wine (17%) on-premise AFTER Sept. 1, 1999 legal sale of beer/wine (14%) on-premise BEFORE Sept. 1, 1999 OR IF ABOVE DOES NOT APPLY: Be advised the location must have had two election passages per Section 25.14 or Section 69.17 of the TABC Code. One for beer and wine off-premise and one for mixed beverage. legal sale of beer and wine for off-premise consumption only AND EITHER: legal sale of mixed beverages OR legal sale of mixed beverages in restaurants by food and beverage certificate holders (applicant must apply for FB with BG BE) SIGN HERE , TEXAS City Secretary/Clerk City S E A L American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 5 Form L-ON (12/2017) CERTIFICATE OF CITY SECRETARY FOR LATE HOURS LICENSE/PERMIT (LB & BL) Chapters 29 & 70 et seq . I hereby certify on this day of , 20 , that one of the below is correct: The governing body of this city has by ordinance authorized the sale of mixed beverages between midnight and 2:00 A.M.; or The governing body of this city has by ordinance authorized the sale of beer between midnight and A.M.; or The population of the city or county