VIRGINIA DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL 2901 Hermitage Road • P 0 Box 27491 • Richmond VA 23261 APPLICANT INSTRUCTIONS 1. Review pages 2 - 4, Definitions and Qualifications and License Types and Costs, to determine the type of license and the amount of license fees that are required. A $65 non-refundable application fee is due for each license applied for and must be submitted with the application. The appropriate license fee is not due until the license is issued and no license can be issued until the appropriate fees are paid in full. 2. Complete pages 5 - 8 of application. Personal Data Form, page 7, is to be completed by each Owner if the applicant is a sole proprietorship, each Partner if the applicant is a partnership, each Member if the applicant is an association, and each Corporate Officer, Director, General Manager, or Shareholder owning ten percent (10%) or more of the corporation’ capital stock, if the applicant is a corporation. s Page 8 is a Personal Data Form for you to make additional copies. 3. Mail or deliver the signed and notarized application, along with your $65 non-refundable application fee to your local ABC office or the Richmond main office. 4. Begin Posting and Publishing requirement (notice insert and pages 9-10). NOTE: Application must be received at ABC prior to beginning posting or publishing. NOTE: The following applicants do not need to post or publish: Airplanes, Boats, Trains, Out-of-State Beer and Wine Importers, Shippers. 5. Complete the Posting and Publishing Summary (page 9) and submit the signed and notarized form to either your local ABC office or the Richmond main office. NOTE: This form cannot be completed until the two newspaper publishings have appeared in the newspaper. Your application will be forwarded to a local ABC special agent for investigation, which will include a criminal history background check. The special agent will contact you to set up an appointment to review your application, obtain any other required information and complete the investigation relating to the issuance of the license. A license cannot be issued until the agent has completed the investigation and has reviewed the applicant’ s completed file. The entire application process routinely takes four (4) weeks; however any of the following factors can increase the time needed to issue the license. • • • • Applications Applications Applications Applications with that that that missing or inaccurate information. do not have documentation readily available for the special agent’ review. s are delayed by a local government review. are contested. IMPORTANT NOTES: If your application is received with the following errors, it will be returned and no investigation will begin until the error is corrected and the application is resubmitted to ABC. • • $65 non-refundable application fee is not submitted. The Sworn Affidavit is incomplete. If you post and publish your intent to apply for a license prior to submitting your application to ABC you will have to repost and republish costing you additional money and valuable time. If you have any questions regarding your application, please contact your local ABC office. a American LegalNet, Inc. www.FormsWorkflow.com American LegalNet, Inc. www.FormsWorkflow.com American LegalNet, Inc. www.FormsWorkflow.com LICENSE TYPES AND COSTS TYPE OF LICENSE TYPE OF BUSINESS Beer On Premises Hotels, restaurants, tax exempt private clubs, food concessions at coliseums and stadia, boats-per-boat, trains-per-car, resort complexes $145.00 Beer Off Premises* Grocery Stores, delicatessens, drugstores, marina stores $120.00 Beer On and Off Premises* Hotels, restaurants, tax exempt private clubs, grocery stores** $300.00 Wine and Beer On Premises Hotels, hotels - limited service, restaurants, tax exempt private clubs, food concessions at coliseums and stadia, boats-per-boat, trains-per-car, resort complexes Airplanes Hospitals Day Spa $300.00 $750.00 $145.00 $100.00 Grocery stores, convenience grocery stores, delicatessens, drugstores, gift shops, gourmet shops $230.00 Wine and Beer On and Off Premises* Hotels, restaurants, tax exempt private clubs, grocery stores** $600.00 Beer Shipper (Brewery, off premises retail business) $65.00 Wine Shipper (Winery, farm winery, off premises retail business) $65.00 Mixed Beverage (On Premises) Hotels, restaurants, resort complexes: Seating capacity 1 to 100 persons Seating capacity 101 to 150 persons Seating capacity 151 persons or more Wine and Beer Off Premises* Mixed Beverage Tax Exempt Private Club Tax exempt private club: Not more than 200 members 201 to 500 members 501 members or more TAX $560.00 $975.00 $1,430.00 $750.00 $1,860.00 $2,765.00 Mixed Beverage Carrier Airplanes Boats-per boat Trains-per car $1,475.00 $560.00 $190.00 Mixed Beverage Caterer Caterers (wine, beer & mixed beverage) $1,860.00 Annual Mixed Beverage Special Event Performing arts facility Bed and Breakfast Wine, beer or mixed beverage to overnight lodgers for on premises consumption Banquet Facility Volunteer fire departments, volunteer rescue squads (no sales) $190.00 Gourmet Brewing Shop Rented facilities for manufacturing, fermenting and bottling beer $230.00 $560.00 $35.00 NOTE: There is a non-refundable $65.00 application fee for EACH license. ** Only in a rural area, must be substantial public demand for public convenience. * To sell kegs off-premises, include an additional $65.00 to tax due. On Premises consumption allows for the sale and consumption of alcoholic beverages on the premises of the licensed establishment. Off Premises consumption allows for the sale of alcoholic beverages to be taken off of the licensed premises. 4 American LegalNet, Inc. www.FormsWorkflow.com Virginia Department of Alcoholic Beverage Control • 2901 Hermitage Road • P.O. Box 27491 • Richmond, VA 23261 • www.abc.virginia.gov APPLICATION FOR LICENSE Please type or print legibly with black ink. Each type of license applied for requires a separate application. (Exception: When applying for a wine, beer and mixed beverage restaurant or club license, these two applications can be combined on one application.) OWNERSHIP INFORMATION j Sole proprietor j Partnership j Limited liability company (LLC) j Corporation j Association j Tax-exempt private club Full name of applicant(s): ___________________________________________________________________________________________________ If sole proprietor, enter first, middle and last names. If partnership, enter partnership name. If LLC, corporation, association or tax-exempt private club, enter name as recorded with State Corporation Commission. Address of applicant: ______________________________________________________________________________________________________ City / town: _____________________________________________ State: ______________ Zip + 4: n n n n n–nnnn Phone number(s): Day: nnn–n n n–nnnn Alt: n n n–nnn–nnnn Fax: nnn–n n n–nnnn E-mail address: ___________________________________________________________________________________________________________ ESTABLISHMENT INFORMATION Trade name: _____________________________________________________________________________________________________________ Exact location (physical address) where business will trade: Street address: _________________________________________________________ City / town: _____________________________________________ State: ______________ Zip + 4: n n n n n–nnnn County: _________________________________________________________________________________________________________________ Phone number(s): Day: nnn–n n n–nnnn Alt: n n n–nnn–nnnn Fax: nnn–n n n–nnnn E-mail address: ___________________________________________________________________________________________________________ Type of license(s) applied for: ________________________________________________________________________________________________ See page 4 for license types and appropriate fees. For each license type applied, a $65 nonrefundable application fee is required to be submitted with the application. All appropriate license fees must be paid before a license can be issued. ESTABLISHMENT MAILING ADDRESS Address: ________________________________________________________________________________________________________________ City / town: _____________________________________________ State: ______________ Zip + 4 nnnnn–nnnn j Owner address j Establishment address j Mailing address j Owner address j Establishment address j Mailing address Mail general correspondence to [choose only one]: Mail annual bills to [choose only one]: OFFICIAL USE ONLY Date received ______________________ Postmark date ______________________ Application fee ______________________ License fee _________________________ CBC fee ___________________________ Total ______________________________ Receipt no. _________________________ Referred to _________________________ Date referred _______________________ Region ____________________________ Territory no. ________________________ j Restaurant j Hotel j Caterer j Club j Boat j Delicatessen j Grocery j Conv. grocery j Drugstore j Gift shop j Gourmet shop j Marina j Bed & breakfast j Brewery j Wholesaler j Importer j Winery j Distillery j Other _________________________ 5 Approval: j Yes j No Hearing: j Yes j No Withdrawn: j Yes j No Refund due: j Yes j No $ __________ Type license _________________________ License no. __________________________ Taxable seats ________________________ ABC store no. ________________________ Date _______________________________ SAC ________________________________ American LegalNet, Inc. www.FormsWorkflow.com American LegalNet, Inc. www.FormsWorkflow.com THE APPLICANT SHOWN BELOW IS APPLYING FOR Full name(s) of applicants Trade Name Exact location where business will trade: City / town VIRGINIA County ZIP American LegalNet, Inc. www.FormsWorkflow.com VIRGINIA DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL 2901 Hermitage Road ! P.O. Box 27491 ! Richmond, VA 23261-7491 LICENSE(S). Sole owner, partner, or corporate officer having an interest in the business: Name Title / nature of interest Name Title / nature of interest Name Title / nature of interest Notice must be posted for 10 consecutive days on the front door where trade is take place. Date notice posted Signature / title American LegalNet, Inc. www.FormsWorkflow.com Virginia Department of Alcoholic Beverage Control • 2901 Hermitage Road • P.O. Box 27491 • Richmond, VA 23261 • www.abc.virginia.gov APPLICATION FOR LICENSE PERSONAL DATA Personal data information must be submitted for each owner if the applicant is a sole proprietorship; for each partner if the applicant is a partnership; for each member if the applicant is an association; and for each corporate officer, dire c t o r, general manager and for shareholders owning 10 percent or more of the corporation’s capital stock if the applicant is a corporation. Note: If additional copies are necessary, please make copies of page 8. Trade name: _____________________________________________________________________________________________________________ Location where business will trade: Street address:_____________________________________________________________________________ City / town: ____________________________________________ County: ______________________________________ State: ___________ Full name: _______________________________________________________________________________________________________________ Please include full first, middle and last names (no initials). nnn–nn–nnnn Driver’s license number: nnn–nn–nnnn nn–nn–nn Place of birth: ________________________________________________________________________ Social security number: Date of birth: Month Day Year For the purpose of conducting a background check, please indicate your gender: j Male j Female j Yes j No If no, please provide your immigration number: _______________________________________________ Do you reside in Virginia? j Yes j No If yes, how long? Years: nn Months: nn Are you a U.S. citizen? Phone number(s): Home phone: nnn–nnn–nnnn Business phone: nnn–nnn–nnnn E-mail address: ___________________________________________________________________________________________________________ Current home address: _____________________________________________________________________________________________________ Previous home address: ____________________________________________________________________________________________________ Complete if you have lived at your current address less than five years. j Sole proprietor j Partner j General manager j Officer j Title: Your relationship to the business: If corporation: j Director ____________________________ Do you currently have financial interest in any business selling alcoholic beverages? If yes, provide license number, trade name and location: nnnnnnn j Shareholder (% owned): ________ j Yes j No __________________________________________________ Have you ever had any type of alcoholic beverage license refused, revoked or suspended? j Yes j No If yes, trade name, location and date: _________________________________________________________________________________________ Have you ever been convicted of any crime, including driving while intoxicated or other motor vehicle offenses? j Yes j No If yes, provide date, location and type of offense (you may use an additional sheet of paper if necessary): ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ Are you an elected or appointed official of the Commonwealth of Virginia or any political subdivision thereof? j Yes j No If yes, provide title and location: _____________________________________________________________________________________________ Provide your full employment history for the past five years: From / to Employed by Address Position ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ FALSIFICATION OF INFORMATION MAY RESULT IN REFUSAL OF LICENSE AND THE CRIMINAL CHARGE OF PERJURY. 7 American LegalNet, Inc. www.FormsWorkflow.com Virginia Department of Alcoholic Beverage Control • 2901 Hermitage Road • P.O. Box 27491 • Richmond, VA 23261 • www.abc.virginia.gov APPLICATION FOR LICENSE PERSONAL DATA Personal data information must be submitted for each owner if the applicant is a sole proprietorship; for each partner if the applicant is a partnership; for each member if the applicant is an association; and for each corporate officer, dire c t o r, general manager and for shareholders owning 10 percent or more of the corporation’s capital stock if the applicant is a corporation. Note: If additional copies are necessary, please make copies of page 8. Trade name: _____________________________________________________________________________________________________________ Location where business will trade: Street address:_____________________________________________________________________________ City / town: ____________________________________________ County: ______________________________________ State: ___________ Full name: _______________________________________________________________________________________________________________ Please include full first, middle and last names (no initials). nnn–nn–nnnn Driver’s license number: nnn–nn–nnnn nn–nn–nn Place of birth: ________________________________________________________________________ Social security number: Date of birth: Month Day Year For the purpose of conducting a background check, please indicate your gender: j Male j Female j Yes j No If no, please provide your immigration number: _______________________________________________ Do you reside in Virginia? j Yes j No If yes, how long? Years: nn Months: nn Are you a U.S. citizen? Phone number(s): Home phone: nnn–nnn–nnnn Business phone: nnn–nnn–nnnn E-mail address: ___________________________________________________________________________________________________________ Current home address: _____________________________________________________________________________________________________ Previous home address: ____________________________________________________________________________________________________ Complete if you have lived at your current address less than five years. j Sole proprietor j Partner j General manager j Officer j Title: Your relationship to the business: If corporation: j Director ____________________________ Do you currently have financial interest in any business selling alcoholic beverages? If yes, provide license number, trade name and location: nnnnnnn j Shareholder (% owned): ________ j Yes j No __________________________________________________ Have you ever had any type of alcoholic beverage license refused, revoked or suspended? j Yes j No If yes, trade name, location and date: _________________________________________________________________________________________ Have you ever been convicted of any crime, including driving while intoxicated or other motor vehicle offenses? j Yes j No If yes, provide date, location and type of offense (you may use an additional sheet of paper if necessary): ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ Are you an elected or appointed official of the Commonwealth of Virginia or any political subdivision thereof? j Yes j No If yes, provide title and location: _____________________________________________________________________________________________ Provide your full employment history for the past five years: From / to Employed by Address Position ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ FALSIFICATION OF INFORMATION MAY RESULT IN REFUSAL OF LICENSE AND THE CRIMINAL CHARGE OF PERJURY. 8 American LegalNet, Inc. www.FormsWorkflow.com American LegalNet, Inc. www.FormsWorkflow.com VIRGINIA DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL 2901 Hermitage Road l P 0 Box 27491 l Richmond VA 23261-7491 APPLICATION FOR LICENSE I PUBLISHING NOTICE Please publish ‘the following in the LEGAL NOTICE SECTION of your newspaper. (Full name(s) of applicants(s) trading as (Trade Name) (Exact location where business will trade: Street Address) (City/Town) Virginia (Zip + 4) (County is applying to the VIRGINIA DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL for a (Type(s) of license(s) applied for) license to sell or manufacture alcoholic beverages. (Name and title of Owner/Partner/Officer authorizing advertisement) IO American LegalNet, Inc. www.FormsWorkflow.com ABC REGIONAL OFFICES Abingdon Region 1 – Roanoke Alexandria Region 4 – Alexandria Chesapeake Region 8 – Chesapeake Hampton Region 7 – Hampton 545 W. Main Street P O Box 205 Abingdon VA 24212-0205 Phone#: (276) 676-5502 Fax#: (276) 676-5549 6308 Grovedale Dr. Alexandria, VA 22310-2551 Phone#: (703) 313-4432 Fax#: (703) 313-4444 1103 South Military Hwy. Chesapeake VA 23320 Phone#: (757) 424-6700 Fax#: (757) 424-6744 4907 West Mercury Blvd P O Box 5226 Newport News VA 23605-0226 Phone#: (757) 825-7830 Fax#: (757) 825-7884 Bland County Bristol City Buchanan County Carroll County Dickenson County Galax City Giles County Grayson County Lee County Montgomery County Norton City Pulaski County Radford City Russell County Scott County Smyth County Tazewell County Washington County Wise County Wythe County Alexandria City Arlington County Fairfax City Fairfax County Falls Church City Loudoun County Manassas City Manassas Park City Prince William County Accomack County Chesapeake City Norfolk City Northampton County Portsmouth City Virginia Beach City Franklin City Gloucester County Hampton City Isle of Wight County James City County Mathews County Middlesex County Newport News City Poquoson City Southampton County Sulfolk City Surry County Williamsbury City York County 11 American LegalNet, Inc. www.FormsWorkflow.com ABC REGIONAL OFFICES Lynchburg Region 2 – Lynchburg Richmond - North Richmond – South Roanoke Region 5 Richmond North Region 6 Richmond South Region 1 – Roanoke Staunton Region 3 – Staunton/ Charlottesville 20353 Timberlake Rd. Suite A P O Box 10336 Lynchburg VA 24506-0336 Phone#: (434) 582-5136 Fax#: (434) 582-5140 2901 Hermitage Road P O Box 27491 Richmond VA 23261-7491 Phone#: (804) 213-4620 Fax#: (804) 213-4638 2901 Hermitage Road P O Box 27491 Richmond VA 23261-7491 Phone#: (804) 213-4624 Fax#: (804) 213-4638 201 Compton St. Roanoke VA 24012 Phone#: (540) 857-6565 Fax#: (540) 857-6540 460 Commerce Square Staunton VA 24401-4432 Phone#: (540) 332-7800 Fax#: (540) 332-7814 Amherst County Appomattox County Bedford City Bedford County Buckingham County Campbell County Charlotte County Cumberland County Danville City Franklin County Halifax County Henry County Lunenburg County Lynchburg City Martinsville City Mecklenburg County Nelson County Patrick County Pittsylvania County Prince Edward County Caroline County Essex County Fredericksburg City Goochland County Hanover County Henrico County King & Queen County King George County King William County Lancaster County New Kent County Northumberland County Richmond County Spotsylvania County Stafford County Westmoreland County Amelia County Brunswick County Charles City County Chesterfield County Colonial Heights City Dinwiddie County Emporia City Greensville County Hopewell City Nottoway County Petersburg City Powhatan County Prince George County Richmond City Sussex County Alleghany County Botetourt County Covington City Craig County Floyd County Roanoke City Roanoke County Salem City Albermarle County Augusta County Bath County Buena Vista City Charlottesville City Clarke County Culpepper County Fauquier County Fluvanna County Frederick County Greene County Harrisonburg City Highland County Lexington City Louisa County Madison County Orange County Page County Rappahannock County Rockbridge County Rockingham County Shenandoah County Staunton City Warren County Waynesboro City Winchester City 12 American LegalNet, Inc. www.FormsWorkflow.com