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R99-138RESOLUTION NO. R99-/.g8 A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF BOYNTON BEACH, FLORIDA, AUTHORIZING AND DIRECTING THE INTERIM CITY MANAGER TO APPLY FOR AND EXECUTE ALL NECESSARY DOCUMENTATION FOR THE ACQUISITION OF A 2 COP W/GC LICENSE TO ALLOW FOR THE SALE OF BEER AND WINE AT THE LINKS OF BOYNTON BEACH RESTAURANT; AND PROVIDING AN EFFECTIVE DATE. WHEREAS, the restaurant services at the Links at Boynton Beach are now under the management and control of the City of Boynton Beach, and in order to maintain the current level of service to the public staff recommends that the City apply for and obtain a 2COP w/GC license to allow for the sale of beer and wine at [he restaurant; NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF BOYNTON BEACH, FLORIDA, THAT: Section 1. The City Commission of the City of Boynton Beach, Florida does hereby authorize and direct the Interim City Manager to apply for and execute all necessary documentation for the acquisition of a 2COP s/GC license to allow for lhe sale of beer and wine at The Links of Boynton Beach restaurant. Section 2. This Resolution shall become effective immediately upon 3assage. PASSED AND ADOPTED this /.~ day of October, 1999. Ma~or Vic,e/M a~yo~r~// Mayor Pro Tem Commissioner Clerk APS APS COP COP PS COP TYPES OF ALCOHOLIC BEVERAGE LICENSES Beer - package sales only Beer and Wine - package sales only Beer - for consumption on premises and package sales (unless package sales are prohi, bJ.l:ed by local Zoning Dept.) Beer and wine for conssmpl::i.on on premJ, ses and package sales (unless package sales are p].:o]Q, bited by local Zoni. ng Dept.) Beer, wine, and liquor package sales only* Beer, wine, and lJ. quor - for consumption on premises and package sales* *'- Quota licenses 4 COP-S Beer, wine, and liquor for consumption on premises and package sales. Premises ipust be a bona-fide hotel, motel, or motor court of not ].ess than 100 transient guest rooms (FSS 56_]..20). 4 COP-SRX Beer, wine, and ].iq,or for consumptJ.~n only. Prealises ,lust be a bona-fide restaurant, with a minimum of 2500 square feet under a permanent roof, accommodations for serving. full course meals to ].50 or more patrons at tables, and 51% or more ~f the 'gross sales must be derived from the sale of food and non-alcoholic beverages (records documenting this must be maintained at the premises). (FSS 561.20) 4 COP-SBX Beer, .wine and ]..i. qnor for consmnption on premi, ses. Must maintaln 12 bowling lanes. 11 C Beer, wine and .liquor for consumption on premises only. This is a special license :issued to specifJ, c types of clubs as de- fined in FSS 56]..20 and 562.02. 11 C Must maintain a bona-fide cour~istinG (G~f) ~ of at least 9 ho~clubhouse, ~ ~~ a~en~t golf facilities and comprising in all at ].east 35 acres. 11 C Must malntain bona-fide club with not ].ess (Tennis) than 10 regulahlon size tennJ, s courts or 4-wa].]. racquetball courts or a combi]~ation I:ota].llng 10 courts, wlth a clubhouse:, locker rooms, and pro shop. JDBW Distributors ].ice,se for beer asd wine. Surety bond of $25,000 is required. KLD Distribntors license for beer, wi. ne and liquor. ~;~lrelly ])on(] :i.$ $].00, 000. IMIPR Impoi:he]Fs ] i.c:en~Je I:.ol; a].]. a].coho]..i.c beve]yagr~. 'l'hi.s license does .oh permi, t possession of hhe a].cohol:i.c beverages. Cigarette Wholesale Distributor Tobacco Proc]ucts Dealers Permit iCWD :RTPDP Retail Additional: Change of Bus. Annual fee $140.C~ $196.0~ $280.00 $392.00 $1365.00 $1820.00 $1820.00 $1820.00 $].820.00 $400.00 $400.00 $400.00 $1250.00 $4000.00 $500.00 Name $10.00; SSo.oo Change Location $35.00 PASSED AND ADOPTED this __ day of October, 1999. CITY OF BOYNTOI~ BEACH, FLORIDA Mayor Vice Mayor Mayor Pro Tem Commissioner Commissioner City Clerk (Corporate Seal) s:ca\Reso\Links 2 COP Lic App DBPR FOR,".! ABT 4000-063L Rev 6/98 STATE OF FLORIDA Department of Business and Professional Regulation Division of Alcoholic Beverages and Tobacco ADM~'ISTRATIVE ESCROW REQUEST and operating u~der License Number ~0~')/~-)~t2~ ,~ does not hav~ fi~t of ~cup=cy to ~efonow~gloeation: ~g~ ~ ~ (Address) The above location has been lea~ed to dokig business as effegtive We request that License Number ~lp~)X~)(D~ ~ ~ be removed from the above location and placed in administrative escrow by the Division of Alcoholic Beverages & Tobacco so that our tenant can obtain a new alcoholic beverage license and/or tobacco permit. Signature of Landlord or Rental Agent Co npany R~O 87~D APPROVED AS lC ?,;'::: A, D · I~'GAL ,~U F FIGfE~'~d ,' T. ri!, Il, ,rlN R~O 872D APPROVED AS TO FORM ~ND LE~3AL SUFFICIENCY Location Address: STATE OF FLORIDA DEPARTMENT OF BUSINESS REGULATION DIVISION OFALCOHOLiCBEVERAGES AND TOBACCO ~.~, License Number: Date: LIST OF LICENSE APPLICATION REQUIREMENTS FOR New Transfer Increase in Series ( ) Decrease in Series ( ) Change in Officers ( ) Change in Series ( ) Other ( ) ChangC in Business Name ( ) TypeLicense~x~C-~ Based on the information you have supplied, the following checked items must be completed and furnished in order for th~ Division of Alcoholic Beverages and Tobacco to accept your application for pro- eessing. Incomplete applications will not be accepted for processing. Application for Alcoholic Beverage License (DBR 424301) must be filed in duplicate with original $igna ,ages, and must include: .~.~x?~_. }Sales Tax Clearance Zoning Approval ,.,.x(. ) Health Approval ..,. ~ ) Federal Employer's Identification Number '-(- ) Sketch of Premiscs to be Licensed "'~' ) F'mancial Disclosure -'DocuMents Verifying Funds Invested in Business '"~) Affidavit bfApplicant '-,~( ) Affdavit of Seller Personal Ouestionnaires (DBR 42-008'~ Must be filed in duplicate with the ori~nal signatures for each applicant or persons connected directly with the business, unless they are current licensees. This will normally include the sole proprietor, al1 general partners, all officers, directors, and shareholders of non-public corporations and the general panners of limited partnerships. Directly interested persons include anyone that is cqnnected with the business who has beneficial interest. DBPR FORM AB"f 4000-037L DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Rev. 9/99 DMSION OF ALCOHOLIC BEVERAGES AND TOBACCO APPLICATION REQUIREMENTS Applications for alcoholic beverage licenses, cigarette wholesale distributor permits, and retail tobacco products de: permits are fried with the Division of Alcoholic Beverages and Tobacco. These applications must be submitted in duplicate (1 original and 1 copy is acceptable) and must be typed or neatly and legibly printed in ink. Ail signatures must be original. Incomplete or illegible applications will not be accepted. We encourage ail applicants to use the appointment system to turn in applications. At the'appointment, the application will be reviewed and accepted if it is complete, and f'mgerprints will be taken. If eligible, a temporary license and/or permit may be purchased. Applications dropped off or mailed in may not be processed on the same day as received, however, they will be reviewed within 7 working days. You will be notified in writing ff any additional information is needed. When you have completed the alcoholic beverage license/permit application and obtained ail of the required approvals, you will need to do one of the following: 1. Call the district office serving your area of interest to make an appointment. 2. Drop off the application. 3. Mail in the application. **NOTE** Florida law prohibits transfer applicants from assuming operation of a licensed establishment and selling alcoholic beverages prior to obtammg a temporary or permanent license m the transferee s ualne. HEALTH APPROVAL: Health approval is required on all applications for consumption on the premises. Businesses that serve food or, are located on a premises licensed by the Division of Hotels and Restaurants must obtain approval from that division. Businesses that do not serve food must contact the County Health Authority or the Department of Health. Food'-~.~ ,,~ service establishments located in grocery and convenience stores, bakeries or delicatessens must contact the Department O Agriculture and Consumer Services. ZONING APPROVAL: Zoning approval is executed by the city or county zoning authority in which the business to be licensed is located. Zoning approval is required on all new and change of location applications unless the applicant is a state college or university located on State owned property. Zoning approval may also be required for certain change or increase in series applications. Zoning approval is not required on new applications for lAPS licenses unless required pursuant to a Special Act. DEPARTMENT OF REVENUE CLEARANCE: Department of Revenue clearance is required on applications for all new, transfer, change of location, and correction of information applications Which change the licensee's name. Contact the Department of Revenue at ( ) AFFIDAVIT OF APPLICANT: Read and sign in the presence of a notary. The affidavit must be signed by the individual applicant; all parmers of a general partnership; all general partners of a limited partnership; or one of the officers of a corporate applicant. AFFIDAVIT OF SELLER: The affidavit of seller must be completed for all transfer applications. The affidavit must be ~igned by the individual owner; all partners of a general partnership; all general partners of a limited partnership; or a corporate officer of record. If the transfer is pursuant to operation of law or judicial proceedings, certified copies of court order(s) in which the applicant is named may be accepted in lieu of signature(s) of seller. ~: Fingerprints must be submitted by all individual applicants, panners, corporate officers, stockholder? owning .5 or more percent of stock, directors, and all general partners of a limited partnership. Fingerprints will be take the time of submission of a completed application and the $39.00 processing fee is payable by cash, check or money orde~ Fingerprinting by other law enforcement agencies must be taken on fingerprint cards provided by the division. If it is mor~ convenient for you to be fingerprinted at a district office other than where the application is being made, you must call that office for an appointment. PERSONAL OUESTIONNAIRE: A personal data for parmer-officer-stockb-older must be filed in duplicate with original ,signatures for each applicant or person(s) directly connected with the business unless they are current licensees. This will include the sole proprietor; all partners; officers; directors; individual Share holders owning more than .5 % of stock in non- public corporations; general partners of general partnerships; general partners of a limited partnersh, ip;' a,n.d, the managing, '¥s of a limited liability company. Directly interested persons include anyone that is connecteu wire me business WhO ha~ ~eneficial interest. It is important that each individual disclose any arrests they have had, even if they were cha~ ~ed, but not formally arrested, and REGARDLESS OF TIlE DISPOSITION. SOCIAL SECURITY NUMBER: Under the Federal Privacy Act, disclosure of Social Security numbers is voluntary unless a Federal statute specifically requires it or allows states to collect the number. In this instance, disclosure of social security numbers is mandatory pursuant to Title 42 United States Code, Sections 653 and 654; and sections 409.2577, 409.2598, and 559.79, Florida Statutes. Social Security numbers are used to allow efficient screening of applicants and licensees by a Title IV-D child sUpport agency to assure compliance with child support obligations. Social Security numbers must also be recorded on all professional and occupational license applications and are used for licensee identification pursuant to the Personal RespOnsibility and Work Opportunity Reconciliation Act of 1996 (Welfare Reform Act), 104 Pub. L.193,Sec. 317. The State of Florida is authorized to collect the social security number of licensees pursuant to the Social Security Act, 42 U.S.C. 405(c)(2)(C)(I). This information is used to identify licensees for tax administration purposes. ..~: Surety bonds are required on all new applications for mannfactnrers, wholesale distributors of alcoholic beverages, whplesale distributors of cigarettes, other tobacco products, importers and broker sales agents. A surety bond or a rider to the or!ginal bond must be submitted on any change of business name, change of location'or change of ownership name applicatil~n by the aforementioned. Contact the Division's district auditing office serving your area of interest for further information. ALCOHOL SURCHARGE ELECTION FORM: Vendors licensed under the beverage 'law to sell alcoholic beverages at ~i~,l~and for ~onsurnnfion on the vremises are required to select a method of calculation for the payment of surcharge. s-e'~ ma~ select ~he purchase'method or sales method. Contact the Division's district auditing office serving your area arest for !further information. CORPORATE AND LIMITED PARTNERSItlP REGISTRATION: All corporations, domestic or foreign; general partnerships; ~imited liability corporations; and limited parmerships are required to be registered with the Florida Secretary of State, Divisiofi of Corporations. If you have not already registered, you will need to contact the Department of State at (850) 488-9000 for further information. Your application cannot be accepted by this Division without this registration. FEDERAL EMPLOYER'S IDENTIFICATION NI.rMBER (FEINt: All licensees who pay wages to one or more employees mdst have a Federal Employer's Identification Number. Contact the internal Revenue Service (IRS) at 1-800-829- 3676 and reqdest Form #SS4. BUREAU OF ALCOHOL. TOBACCO AND FIREARMS REGISTRATION: Businesses selling alcoholic beverages are subject to the Federal "Special (OccupaUonal) Tax". This tax is due before the commencement of busmess. The fee is $250.00 per ~ear for retail dealers and $500.00 per year for wholesale dealers. For more information contact your nearest BATF regional office. OUOTA TR)~NSFER FEE: The transfer fee on quota liquor licenses is assessed on the average annual value of gross sales of alcoholic l~everages for the three (3) years immediately preceding transfer or from the date transferor acquired~the lice..nse if less than three (3) years. The fee is levied at the rate of four mils and in no event exceeds $5000.00. In lieu ot proviamg records for c~mputation of the transfer fee, the applicant may elect to pay the $5000.00. The following are acceptable records for c~mputing the transfer fee: 1.~ '~epartm~nt of Revenue sales tax records. ~ dstribut0r records. dash re~,i~ter receipts, bank records, accounting records and income tax records. · 7 'on a notarized affidavit of transferor estimating a percentage In addition to documentati , of gross alcoholic beverage 4. sales w~en gross sales do not show a breakdown. C~: Applicants for club licenses, other than fraternal organizations, must submit club by-laws, and articles of incorporation. FINANCIAL DOCUMENTATION: Documentation of finances is required for each person or entity having an interest this business, i.e. copy of loans (whether they are from a traditional lending institution, family member, or friend), gift affidavit, 3 months of bank statements, etc. **NOTE** When applicable you must submit two legible copies of the following: Lease, Pumhase Agreements, Franchise Agreements, Management Contracts, Service Agreements, and any Agreements which require a percentage payment from the business operation; Certified Copy of Death Certificate; Letters of Administration; Certificate of Title; Certified Copy of All Court Orders pertaining to the alcoholic beverage license. .qK'I~.TCH OF PREMISES: Draw, in ink, a complete sketch of the premises which includes all walls, doors, counters, sales areas, storage areas, etc. See example below. La~ies [ Mens Room Room Storage Kitchen Back Door Seating Area Bar Office Patio BPP- FORM ABT 4000-00IL STATE OF FLORIDA Rev 5/99 Department of Business and Professional Regulation Division of Alcoholic Beverages and Tobacco LICENSE/PERMIT APPLICATION ase read the instructions before completing this application SECTION I- LICENSE hNFORMATION BUSINESS TELEPHONE A. TY'PE OF LICENSE: Check Appropriate Boxes etafl Alcoholic Beverages eer/Wine/Liquor Wholesaler lcoholic Beverage Importer/Exporter U Alcohoiic Beverage Manufacturer --~ Retail Tobacco Products ~_~1 Cigarette/Tobacco Wholesaler ~_~1 Tobacco Exporter Cigarette Dis~:ibuting Agenl Change of Location Change of Business Name Change, of Officers/Stockholders B. TYPE OF APPLICATION: Check Appropriate Boxes Change in Series Decrease in Series Increase in Series Correction Series requested: Do you wish to purchase a temporary? YES __ 1. Type requested: [ ~' C NO ~ Corporate Document # FullNameofApplicant: 0 ['~\ OJ~ ~'-'~'.'~'~"x~'~ ~-'~9,-C ~ (If this is a ~o¢oration or oth~ le~l enti~ enter the name as registered with Secmm~ of Smtel Enter document ~ above 6. Enter FeOeral Employer ID# or SS#: FEIN#: ,~--C~ _ ~p~('-,f~ ~ ~ ~ If application is for a NEW license/permit, question 7-8 are not applicable. ~'~, Current ]License Number: Series: Current [Business Name: Zip Code: Zip Code: SS#: Type: ¸9. Is the tr~tnsfer of tins hcense due to revocatton proceedings? If yes, iS there any personal relauonship to the transferor. Explainlthe relationship: SECTION H - DESCRIPTION OF PREMISES TO BE LICENSED A. Is the proposed premises MOVABLE or ABLE TO BE MOVED? ........................ YES B. Is the proposed premises located in a shopping center, mall or office building? ..... YES C. Is there any access through the premises to any area over which you do not have domin/on and control? ............................................................................................. YES NO NO NO 'X D. Is the premises occupied by anyone not listed on this application? ....................... YES NO X' E. Neatly draw a floor plan of the premises in INK, including sidexvalks and other outside areas which are contiguous to the premises, walls, doors, counters, sales areas, storage areas, restrooms, bar locations and any other specific areas which are part of the premises sought to be licensed. A multi-story building where the entire building is to be licensed must show each floor plan. ~9'~ ,, PAGE 2 SECTION III - SALES TAX - To be completed by the Department of Revenue. Thee named applicant for a license/permit has complied with Florida Statutes concerning registration for Sales and Use tax. This is to verify that the current owner as named in this application has filed all returns and that all outstanding billings and returns appear to have been paid through the period ending or the liability has been acknowledged and agreed to be paid by the applicant. This verification does not constitute a certificate as contained in Section 212.10 (1), P.S. (Not applicable if no uansfer involved.) ..... m,,liad ,-,;*~' ~:~,,,4aa Statutes concemia~ registration for 2. Furtherm°re, the named applicant for an Alcohohc Beverage ~manse nas co-~v ............... Sales and Use Tax, and has paid any applicable taxes due. Department of Revenue Stamp Signed: ~ Tire: Date: SECTION IV - ZONING - To be completed by the Zoning Authority governing your business location. Street Address: i State: Zip Code: q~i,. ! ,... · ~A_ ,~ '~o"ance of an alcoholic beverage license where zoning appro.v, al is required, ~e. · AI mis application is JUl m~ t~u ,, , z.°ning ~Uthority must complete "A" and B . If zoning approval is not required, the apphcant must comptere . ~sectjon A. The location complies with zoning requirements for the sale of alcoholic beverages or wholesale tobacco prodhcts pursuant to this application for a Series. alcoholic beverage or wholesale tobacco license. Signed: ! Title: Date: ~+ ation within the limits of an "Incorporated City or Town? YES [ ] NO [ ] B. Is lo,c, If YES , enter name of City or Town .......................... :......i ....... ; .............. Autho ~ty or Department of Heal~ or me ~epartmCm o~,, applicable. AddresS: The abbve establishment Complies with the requirements of the Florida Sanitary Code. Signed:I Date: Title: Agency: PAGE 3 SECTION VI These questions must be answered about this business for every person or entity listed. Copies of agreements and documentation to support the financial arrangements must be submitted with this application. 1. Is there a management contract or service agreement in connection with this business? YES 2. Are there any agreements which require a payment of a percentage of gross or net receipts from the business operation? YES __ 3. Have you or anyone listed on this application accepted money, equipment or anything of value in connection with this business from any source connected with the alcoholic beverage industry? YES __ 4. Do you have a loan from a source other than a traditienal lending institution? If yes, what is the source? YES __ 5. If purchasing the business, what is the purchase price? .............................................................................. 6. List the total investment, ............................................................................................................................. SECTION VII Has the applicant corporation been convicted of a felony in this state, any other state, or by the United States in the last 15 years? YES NO If the answer is "YES", please list all of the particulars including the date of cenviction, the crime for which the corporation was convicted and the City, County State and Court where the conviction took place. Attach extra sheets if ne(~.~alW ..... ~ SECTION VIII ~and wine lic~ [~ Quota Alcoholic Beverage License ] [ Special Alcoholic Beverage License This license is issued pursuant to - requirements must be met and mammm,u. [~ Club Alcoholic Beverage License ,Florida Statute or Special Act and as such we acknowledge the following PLEASE INITIAL AND DATE: Applicant's Initials: PAGE 4 SECTION IX A. List below the names, titles and interest for ali officers, directors, stockholders, limited partners and general partners of the corporation or other legal entity for Which this license or permit is being sought. At~ach extra Sheets if necessary. ITLEfPOSITION NAME STOCK % President: Vice President: Secretary: Director(s) ( Stockholder(s): Bar Manager (if Applicable): B. List below the names and type of interest (~.e. tender, joint account hotder, co-s~gner) for all persons or ent~t~es not hsted ~n Pan who ha NAME (A) above, ~e an interest, directly or indirectly, in this application or the business for which the license/permit is sought. This may include a corporations, or any form of entity which is connected with this business. TYPE OF INTEREST PAGE 5 TRADE NAM~ (D/B/A): APPLICANT NAME: AFFIDAVIT OF APPLICANTS "1 th~ undersio'ned individuallv, or if a comoration for itself, it's officers and dire~ors hereby swear or affirm that I am duly authorized to make the above and foregoing app!maUon an~, as such I hereby swear or affirm th.? the att~coh,?d sketch or b!uepnnt is s.ubsta, ntlally, a .true correct re resentation of the premises to be licensed and agree that the place of 15uslness, ir hcenseu, may oe mspectea ana searcneo our~ business hours or at anytime business is bemg conducted on the premises vathout a search warrant by officers of the Division of Alcohq Beverages and Tobacco, the Sheriff, his Deputies, and Pohce Officers for the purposes of determining compliance with the beverage cigarette laws. I swear under oath or affirmation under penalty of perjury as provided for in Florida Statutes 559.791,562.45, and 837.06, that the foregoing information is tree and that no other person or entity except as indicated herein has an interest in the alcoholic beverage license and/or cigarette permit and that all of the above listed persons or entities meet the qualifications necessary to hold an interest in the alcoholic beverage license and/or cigarette permit." STATE OF APPLICANT (Signature Must be Notarized) COUNTY OF APPLICANT (Signature Must be Notarized) The foregoing was Sworn to and Subscribed OR ( Acknowledged Before me this __Day of By , who is ( ) personally known t9 me OR ) who produced as identification. Commission Expires: Notary Public AFFIDAVIT OF SELLERS "I, the undersigned, hereby swear or affirm that I am duly authorized to make this affidavit and do hereby consent, on my behalf or on,.~ behalf of the seller, to the above transfer, and represent to the Division of Alcoholic Beverages and Tobacco that the license which is bei transferred is as shown in the application and that a bona fide sale in good faith has bean made to the within applicant of the business ~vhich the foregoing transfer of license is sought." -- STATE OF SELLER OR AUTHORIZED OFFICER (Signature Must be Notarized) COUNTY OF The foregoing was By Sworn to and Subscribed OR ( SELLER OR AUTHORIZED OFFICER (Signature Must be Notarized) Acknowledged Before me this Day of ,who is ( ) personally known to me OR ) who produced as identification. Notary Public Commission Expires: FOR DIVISION USE ONLY - DO NOT WRITE BELOW THIS LINE District Office Date Stamp CODE: City County FEIN NUMBER TYPE: FEE: Total: Unaudited: Approved by: Date: Audited: PAGE 7 CURRENT LICENSEE UPDATE DATA SHEET To be completed for all current license holders listed on the application NAME: Last DATE OF BIRTH / / Mo. day CURRENT RESIDENCE ADDRESS yr. First Middle SOCIAL SECURITY # / / City CURRENT LICENSE NUMBER(S) State NAME: Last DATE OF BIRTH / / Mo. day v v'RRENTiRESIDENCE ADDRESS yr. First Middle SOCIAL SECURITY # / CURRENT LICENSE NUMBER(S) State /) NAME: Last DATE OF BIRTH / __ / Mo. day CURREN'~ RESIDENCE ADDRESS yr. First Middle SOCIAL SECURITY # / / ~ City IRREN~ LICENSE NUMBER(S) State /) /) Zip PAGE 8 61A-I.017 Moral Character. (1) For purposes of the Beverage La'v, a person of "good moral character" shall mean a person who: (a) Has the ability to distinguish between right and wrong and the character to observe the difference; (b) Observes the rules of right conduct; and (c) Acts in a manner that indicates and establishes the qualities of trust and confidence that is generally acceptable to the state. (2) Conduct that does not establish the qualities of trust and confidence include the following: (a) Being penalized for a criminal act in this country or a foreign country that is punishable bY imprisonment for a term exceeding 1 year when the act is related to alcoholic beverages, failure to pay taxes, unlawful drugs or controlled substances, prostitution, or inji~ring another person in the preceding 15 years; (b) Committing two or more crimes in this ~'ountry or a foreign country that are punishable by imprisonment for a term exceeding 1 year, unless found not guilty by a court of competent jurisdiction, during the preceding 5 years; (c) Committing an unlawful lewd, lascivious, or indecent assault or act upon or in the presence of a person under the age of 16, unless found not guilty by a court of competent jurisdiction, during the preceding 5 years; (d) Having a delinquent child support obligation which has resulted in issuance of a court order for collection within the preceding 5 years; (e) Committing two or more acts of prostitution or lewdness, unless found not gfiilty by a court of competent jurisdiction, during the preceding 5 years; (f) Committing an act of unlawful battery, unless found not guilty by a court of competent jurisdiction, during the preceding 5 years; (g) Committing an act of selling, delivering, giving, or possession with the intent to sell, give, or deliver unlawful controlled substances or drugs, unless found not guilty by a court of competent jurisdiction, during the preceding 5 years; (h) Committing two or more acts in viol.ation of alcoholic beverage laws, unless found not guilty by a cou of competent jurisdiction, during the preceding 5 years; ~__ (i) Committing perjury or giving false information under oath to a government agency or court, unless found not guilty by a court of competent jurisdiction during the preceding 5 years; 0) Engaging in a pattern of fraud as defined in section 409.327, Florida Statutes, unless found not guilty by a court of competent jurisdiction during the preceding 5 years; and (k) Having had an ownership interest or managed a business whose alcoholic beverage license or permit was revoked bY a government agency for a violation ora criminal law that is punishable by imprisonment for a term exceeding i year, or fourv olations of the same law during the preceding 3 years. . - .4 · , (3) Mitigation the d~v~s~on w~ cons ~er n determ n ~g a person s good moral character when there is evidence of the conduct described in subsection (2) of this rule includes: (a) An affidavit explaining the circumstances of past conduct and evidence of the qualities of trust and confidence, the ability to distinguish between right and wrong, and the character to observe the difference; and (b) Character references from people who have personal knowledge of the applicant's or licensee's qualities of trust and confidence, the ability to distinguish between right and wrong, and the character to observe the difference. References may not include spouse, sons, daughters, or any one employed by the applicant or licensee.* (c) Evidence of good citizenship and improving the quality of life in their community.** **Applicant tnust also provide a copy of the arresting agency's arrest report** This rule applies to all arrest dispositions except NOT GUILTY (actual finding of Not Guilty by a judge or a jury) hud ~ ~.~, NOLLE PROSSED (state attorney's office declined pro~cution). · . *Employees include your attorney, accountant, bar3:er, or anyone you pay to provide a service to you. **Evidenc~ of good citizeuslfip, etc.: i.e. letters from civic or charitable organlzado~s, churcli, social clubs, etc. ' DEPARTMENT OF BUSINESS & PROFESSIONAL REGULATION DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO 1940 North Monroe Street-Tallahassee, Florida 32399-1022 ELECTION OF SURCHARGE CALCULATION METHOD AND INVENTORY REPORT This application is for a: ~ New License [] Transfer of a License I hereby elect to pay future surcharges based on the: [] PURCHASE METHOD [] SALES METHOD Applicant's Name: Business Name: -'~ Mailing Address: Location Address: ~C5o'~O '~'C*c~ r~OC~ ,FL Alcoholic Beverage License Number: Series: ,FL County.~_n Zip: Applicant k Signatare Title Date Applicantl Name: Business Name: Former owner certifies that the U] Purchase method [] Sales Method was used to calculate the beverage surcharge and that all surch; rges have been paid as of FOR LICENSE TRANSFERS LicenseNumber: License Series: New owner and former owner certify that the following inventory is being transferred for consumption on premises: Gallons of Draft Beer Gallons of Packaged Beer Gallons of Coolers Gallons of Wine Gallons of Liquor Signature of Former Owner Date Signature of New Owner/Applicant Date BPR 44-005Ez REV. 7/95 DBPR FORM ABT 4000-052L Rev 6/99 STATE OF FLORIDA DEPARTMENT OF BUSINESS & PROFESSIONAL REGULATION Division of Alcoholic Beverages and Tobacco LICENSE/PERMIT APPLICATION WAIVER Please check appropriate box: []90 Day Waiver [-'] 180 Day Waiver (New Quota Issuance Only) Chapters 120 and 561 of the Florida Statues require your application be processed within 90 or 180 days. The Division of Alcoholic Beverages and Tobacco may be unable to meet the time requirements in your case. Therefore, the Division requests you waive the time requirements for processing your application. Your application will be processed as expeditiously as possible. If you wish to waive the above limitations, please complete the following: Business Name: Applicant's Name: Business Address: Street Number Telephone No.: City County Zip I do hereby waive all time restrictions surrounding the processing of the above .referenced application. I do so knowingly and voluntarily. Date Signature of Applicant Your Full Name: 3. Social SecurityNumber: II [ I ]]'1 I ['[] [ [ [[ Home PhoneNumber: [[ [ [ I']l ] ] [[-[[ [ ] [ [[ 4. Date ofBirth:mm/dd/yy: 1~[-~[~]-~__~ Place of Birth: Race: Sex: Height:. Eye Color: Hair Color: 5. Are you a U.S. citizen? YES N If NO, immigration card number or passport # 6. Complete home address (City, St., Zip) 7. Your relationship to the business: ~] Sole owner [~[ Parmer If corpora((ion: D Director ~] Officer (Title) DOther ~---]Sha~eholder (% owned) Do you c~rrently have interest in any business selling alcoholic beverages or wholesale cigarette or tobacco products? If yes, D/B/A-Business name, location and license number. Yes0 Have you lever had any type of alcoholic beverage cigarette or tobacco permit refused, revoked or suspended ~ . ' Yes · ANYWHERE in the past 15 years? If yes, D/B/A-business name, location, and date. lO. Have you ~een convicted of a felony, a crime involving moral turpitude or an offense involving alcoholic beverages anywhere? Yes No If yes, date, location, and type of offense on a separate sheet of paper and provide a CERTIFIED COPY OF DISPOSITION. If yon art a convicted felon and have had your civil rights restored in Florida, ATTACH A CERTIFIED COPY 11. Have you [had any criminal charges filed against you within the past 15 years? YesD ] No [~] If yes, date, location, and type of offanse on a separate sheet of paper. 12. Have you ever been arrested or issued a notice to appear in any state of the United States or it's territories? Yes [~i NoD If yes, date, location, and type of offanse on a separate sheet of paper. 13. Are you a~ official with State police powers granted by the Florida Legislature? Yes N No N If yes, please provide the details. II II II }1 What is th}e amount and source of your investment? Documentation must be provided. "I swear ahd affirm under penalty of perjury as provided for in 559.791, 562.45 and 837.06, Florida Statutes that the fqregoing information is true and correct." ate: iD Produced: Personally known to me [ ] Notary Public Stamp/Seal (Signature iof applicant) PAGE 6 DBPR FORM ABT 4000-026/., Rev. 4/99 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Division of Alcoholic Beverages and Tobacco AFFIDAVIT In compliance with Florida Beverage Laws and Regulations I hereby certify Name: First Middle Last Complete Home Address: was t'mgerprinted by me for the Florida State Division of Alcoholic Beverages and Tobacco, and that the attached f'mgerprints are his]hers. Officer Name and Badge Number (please print) Signature of OffiCer Depa~:hiient