For Office Use Only Liquor Control Board Licensing and Regulation PO Box 43098 Olympia WA 98504-3098 www.liq.wa.gov 360/664-1600 Fax: (360) 753-2710 Date Check No. Amount Rec’d Rec’d By License No. Application for Nonprofit Arts Organization Liquor License $250 Fee (Make check payable to WSLCB) A Nonprofit Arts Organization liquor license is issued to a bona fide nonprofit organization, to sell beer, wine and spirits in conjunction with artistic or cultural exhibitions or performances (see the back of this form for more information). Questions? Please call the customer service desk at (360) 664-1600 Applicant Information 1. Organization name Mailing address Street/Route/PO Box State Zip Street/Route/PO Box Liquor license address (if City City State Zip different) Phone 2. ( ) Name of person responsible for day-to-day operations Business Phone ( ) Home Phone ( ) Organization Information 1. Number of members in organization 2. Is association registered as a nonprofit organization with the Washington Secretary of State?.................................….................................................................................. Secretary of State File No: 3. 4. 5. YES NO Does the organization have any interest, financial or otherwise, in any manufacturer, distributor, or importer of beer, wine, or spirits?..........................................….............. YES NO Does a manufacturer, distributor, or importer of beer, wine, or spirits have any interest in the organization, financial or otherwise?.........................................…......... YES NO Will any of the members, officers, or directors receive direct or indirect monetary payment from the proceeds of the sale of liquor?..................................…................... YES NO If yes, please attach explanation and indicate amount. Current Officers of the Organization Name LIQ 612-50 6/99 (attach additional sheets if necessary) Phone Date Mailing Address Number of Birth Social Security No. Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Current Directors of the Organization Name (attach additional sheet if necessary) Phone Date Mailing Address Number of Birth Social Security No. Qualifications and Certification As representative of the applicant organization, I certify the organization meets the following requirements: ? The organization is organized and operated for the purpose of providing artistic or cultural exhibitions, presentations, or performances, or cultural or art education programs for attendance by the general public, which includes: ? An exhibition or presentation of works of art or objects of cultural or historical significance (such as those commonly displayed in an art or history museum); or ? A musical or dramatic performance; or ? An educational seminar or program on an artistic, cultural, or historical subject. ? The organization is a bona fide not-for-profit corporation (per RCW 24.03) managed by a governing board of not less than eight individuals, none of whom is a paid employee of the organization. ? In addition, the corporation satisfies the following conditions: ? No part of its income is paid directly or indirectly to its members, stockholders, officers, directors, or trustees (except in the form of services rendered to the corporation in accordance with its purposes and bylaws). ? Salary or compensation paid to officers and executives is only for actual services rendered, and at a level comparable to the salary or compensation of like positions within the state. ? Assets of the corporation are dedicated to the activities for which the license is granted. Upon the liquidation or dissolution of the corporation, the assets will not benefit any member or individual except a nonprofit organization. ? The proceeds from the sale of liquor (except reasonable operation costs) will be used to further the purpose of the organization. ? Services are available regardless of race, color, national origin, or ancestry. ? The Liquor Control Board shall have access to the corporation’s books in order to determine whether the corporation is entitled to a liquor license. Signature LIQ 612-50 6/99 Title Date Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com