PRIVATE CLUBS TRADE NAME: 1. FORM L-101-N (12/2007) Option 1 - Membership Option 2 - Set Fees If applying for a Private Club Registration Permit (N), indicate your permit fee payment option: 2. If applying for a Private Club Registration Permit (N), indicate the current club membership: 3A. Federal Employer’s I.D. No.: FO R P R I V A T E C L U B S O N L Y – C O R P O R A T I O N O R U N I N C O R P O R A T E D ASSOCIATION OF PERSONS OFFICER(S) AND DIRECTOR(S) B. Entity Name: C. Charter No.: Date Approved (If applicable): / / 4. Complete the following: Social Security Number - Issuing State/Driver’s License Number Full Legal Name (Last, First, Middle) Date of Birth (mm/dd/yyyy) / Officer Director Residential Address / Position/Title City State ZIP Code (9 Digits) - Social Security Number - Issuing State/Driver’s License Number / - Full Legal Name (Last, First, Middle) Date of Birth (mm/dd/yyyy) Officer Director Residential Address / Position/Title City State ZIP Code (9 Digits) - Social Security Number - Issuing State/Driver’s License Number / - Full Legal Name (Last, First, Middle) Date of Birth (mm/dd/yyyy) Officer Director Residential Address / Position/Title City State ZIP Code (9 Digits) - Social Security Number - Issuing State/Driver’s License Number Full Legal Name (Last, First, Middle) Date of Birth (mm/dd/yyyy) / Officer Director Residential Address / Position/Title City State ZIP Code (9 Digits) - N & NB 5A. List names of all members on membership committee: B. Is any member of the membership committee directly or indirectly employed by the club? 5B. YES NO If “YES,” explain employment relationship. (IF MORE SPACE IS NEEDED, USE COPIES OF THIS PAGE.) Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com PRIVATE CLUBS TRADE NAME: FORM L-101-N (12/2007) PRIVATE CLUB REGISTRATION/ PRIVATE CLUB BEER & WINE 6. If renewal, indicate the most members in good standing for the previous year: 7. Does the club have at least 50 members who reside in the county where the club is located or at least 100 members who reside in that county and an adjacent county or counties? NOTE: Attach copies of membership lists. 7. YES NO 8A. POOL LOCKER of all alcoholic beverages? B. YES NO Is regular food service at this location adequate for members and guests? 9. YES NO 8A. Indicate which type of liquor storage system club members will use: B. If operating under the pool system, has each member of the pool participated equally in the purchase 9. 10. Are all members at least 21 years old? 10. YES NO 11. Is the club located within the incorporated limits of the city? 11. YES NO 12. Veteran Fraternal Building/Hall Association PRIVATE CLUB EXEMPTION CERTIFICATE 12. Indicate whether the organization is a veteran, fraternal or building/hall association: 13A. If applicant is a veteran or fraternal organization, enter official name and address of parent organization: B. Indicate whether the organization is an American national or Texas State fraternal organization: 13B. American national Texas state fraternal C. If fraternal, has this local unit operated an establishment for fraternal purposes at least one year? 14. If applicant is a building or hall association: A. Is all stock owned by the local unit or members of the local unit of the fraternal organization that 13C. YES NO 14A. YES NO B. YES NO 15A. YES NO B. YES NO YES NO YES NO operates the club facilities of the local unit? B. Is the association composed of members appointed by the county commissioner’s court to administer, manage and control an exposition center? 15. If the applicant is a building association appointed to control and manage an exposition center: A. Is the exhibition area at least 100,000 square feet? B. Does the arena have at least 6,000 fixed seats? C. Is the exhibition area situated on property within an area of at least 50 acres including buildings and appurtenances owned by the county? Are all members at least 21 years old? 17. PRIVATE CLUB LATE HOURS 16. C. 16. Is the club located within the incorporated limits of the city? 17. YES NO 18. To determine whether the club is authorized to receive a Private Club Late Hours Permit, answer one of the following questions, whichever is applicable: 18A. YES NO B. YES NO C. YES NO A. Is the proposed licensed location in a county/city that had a 500,000 or more population according to the last federal census? B. If the proposed licensed location is in an unincorporated area of a county having less than 500,000 according to the last federal census, has the county commissioner’s court adopted by order the late hours of consumption of alcoholic beverages? C. If the proposed licensed location is in an incorporated city or town in a county having less than 500,000 according to the last federal census, has the governing body of the city/town adopted by ordinance the late hours of consumption of alcoholic beverages? Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com