Application for Liquor License

Date

Applicant - Corporate Information

FEIN

ILLINOIS BUSINESS TAX NUMBER

ILLINOIS LIQUOR LICENSE NUMBER

Contact Information

Name

Address

Phone

Email

Status of Buisness

Checkboxes

Partnership

Illinois Corporation

Foreign Corporation

Date of Formation

Date of Incorporation IL

Date of Incorporation Foreign

State of Incorporation

Date Qualified to Do Buisness in Illinois

Navigate to the website below to pay online:

Ownership Information

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(A) For each owner, partner, corporate officer or director (whether or not they own any stock), and/or shareholder owning in the aggregate equal to or more than 5% of the stock, provide full name, home address, city, state, zip code, social security number, date of birth, sex, title/position, home telephone number, and percentage ownership.  Percentage ownership should equal 100%.  If there are a number of shareholders owning less than 5%, indicate the aggregate total of ownership.  If additional space is needed, provide information on a separate sheet in the same format. No License shall be issued to a person that has not submitted to a City background check to determine compliance with eligibility requirements of Section 110.17 prior to the initial issuance of any license to an applicant, A new background check will only be required if the owners, sole proprietor or resident manager changes.  The applicant shall, in addition to the license fee thereinafter set forth, reimburse the City for the actual cost of the background check. Notwithstanding the foregoing, background checks will not be required for applicants for Class F and Class H licenses.

Full Name

Address

City

State/Province

Zip/Postal

Country

SSN *

DOB

Sex

Title Position

Percentage Owned

Add Another Owner

Yes

No

Ownership Information

Full Name

Address

City

State/Province

Zip/Postal

Country

SSN

DOB

Sex

Title Position

Percentage Owned

Add Another Owner 2

Yes

No

Ownership Information

Full Name

Address

City

State/Province

Zip/Postal

Country

SSN

DOB

Sex

Title Position

Percentage Owned

TOTAL PERCENTAGE OF ALL STOCK HELD BY ALL PERSONS WITH LESS THAN 5%

Percentage

Business Premises Information

Enter the name of the business. NOTE: THIS NAME WILL APPEAR ON YOUR LIQUOR LICENSE AND MUST BE CONSISTENT WITH THE NAME PRINTED ON YOUR ILLINOIS DEPARTMENT OF REVENUE SALES TAX CERTIFICATE. If operating under an assumed name, attach written proof that the Illinois Assumed Business Name Act has been satisfied.

NAME / DOING BUSINESS AS (D/B/A)

Phone

Address

Owned Premises

Enter the 14-digit Henry County Property Tax Identification Number. Attach a copy of the deed of ownership.

Leased Premises

Landlords Name

Address

Landlords Address

Diagram of Premise

Maximum upload size: 104.86MB

Attach an accurate diagram of the business premises SHOWING ALL EXITS AND LOCATIONS WHERE LIQUOR WILL BE STORED, DISPENSED, SOLD, OR CONSUMED.

Fee Section

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FEE SCHEDULE   LICENSE CLASSIFICATION FEE 
Class A - General  $750.00 
Supplemental Liquor License - Class A Only $250.00 
Class B - Package Store  $750.00 
               Supplemental Liquor License – Class B Only             $250.00 
Class C - Restaurant, Beer and Wine On Premises Only $750.00 
               Supplemental Liquor License – Class C Only $250.00 
Class D - Restaurant, Alcoholic Liquor On Premises Only $750.00 
Class E - Other Business, Beer and Wine Off Premises Only $750.00 
Class G – Brew Pub $1,000.00

Fee Submittted With Application - Liquor License Fee

City of Geneseo Liquor License

Option – ½ Year Liquor License Payment (2nd half due by October 30)

Entertainment License - Annual ($250.00)

Entertainment License – One Time ($50.00)

Juke Box License ($25.00)

Amusement License - $35 per machine

Tobacco License ($50.00)

Other Fees First Time Applicants

Administrative Fee ($750.00)

Background/Fingerprinting (36.50)

Public Hearing Processing Fee ($200.00)

Bassett Training for Servers – Submit Proof of Training Per Server N/C

TOTAL AMOUNT SUBMITTED Payment Options: Online Payment or Check made out to City of Geneseo (Payment must be received before Application is processed)

Eligibility Questions

These questions apply to any person listed under question 3. These questions must be answered or the application will be rejected. If any question is checked YES, a detailed, written explanation is required and must be attached to this application.

BEEN CONVICTED OF A FELONY?

Yes

No

BEEN CONVICTED OF A GAMBLING OFFENSE?

Yes

No

EVER APPLIED FOR AND BEEN DENIED A LIQUOR LICENSE?

Yes

No

EVER HAD ANY PREVIOUS LIQUOR LICENSE OF WHICH HE/SHE WAS A PART OF THE APPLICATION REVOKED?

Yes

No

BEEN CONVICTED OF A VIOLATION OF ANY FEDERAL OR STATE LAW CONCERNING THE MANUFACTURE, POSSESSION, OR SALE OF ALCOHOLIC LIQUOR OR FORFEITED A BOND TO APPEAR IN COURT TO ANSWER CHARGES FOR ANY SUCH VIOLATION?

Yes

No

BEEN CONVICTED OF A VIOLATION OF ANY FEDERAL OR STATE LAW CONCERNING THE MANUFACTURE, POSSESSION, OR SALE OF ALCOHOLIC LIQUOR OR FORFEITED A BOND TO APPEAR IN COURT TO ANSWER CHARGES FOR ANY SUCH VIOLATION?

Yes

No

CURRENTLY SERVING IN AN ELECTED POSITION OR AS A LAW ENFORCEMENT OFFICIAL IN ANY GOVERNMENTAL ENTITY?

Yes

No

IF YES, PLEASE LIST TITLE AND TYPE OF GOVERNMENTAL ENTITY.

NOT A CITIZEN OF THE UNITED STATES OF AMERICA?

Yes

No

ARE YOU OR YOUR PARTNER(S) CURRENTLY NOT CITIZENS OF THE UNITED STATES OR RESIDENT ALIENS WITH LEGAL STATUS?

Yes

No

Resident Manger or Sole Proprietor Information

Full Name

Phone Number

SSN

DOB

Home Address

How long have you resided at this address

Drivers License Number

Drivers License Experation

Attach a copy of Drivers License

Maximum upload size: 104.86MB

HAVE YOU EVER BEEN CONVICTED OF A FELONY?

Yes

No

HAVE YOU EVER BEEN CONVICTED OF A GAMBLING OFFENSE?

Yes

No

HAVE YOU EVER APPLIED FOR AND BEEN DENIED A LIQUOR LICENSE?

Yes

No

HAVE YOU EVER HAD ANY PREVIOUS LIQUOR LICENSE OF WHICH YOU WERE A PART OF THE APPLICATION REVOKED?

Yes

No

ARE YOU CURRENTLY SERVING IN AN ELECTED POSITION OR AS A LAW ENFORCEMENT OFFICIAL IN ANY GOVERNMENTAL ENTITY?

Yes

No

IF YES, PLEASE LIST TITLE AND TYPE OF GOVERNMENTAL ENTITY.

WERE YOU BORN OUTSIDE OF THE UNITED STATES OF AMERICA?

Yes

No

ARE YOU A CITIZEN OF THE UNITED STATES OF AMERICA?

Yes

No

IF A NATURALIZED CITIZEN, PROVIDE THE FOLLOWING INFORMATION:

Date of Naturalization City and State

I, THE UNDERSIGNED, UNDER PENALTIES OF PERJURY, SWEAR OR AFFIRM THAT THE ABOVE INFORMATION IS TRUE AND CORRECT. SHOULD ANY OF THE ABOVE INFORMATION CHANGE, I AGREE TO NOTIFY THE LIQUOR COMMISSIONER WITHIN SEVEN DAYS OF THE CHANGE.

Printed Name and Dated is your Electronic Signature

BASSETT TRAINING LIST Per City of Geneseo Liquor Ordinance Section 110.17Q

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     (Q) An applicant for any liquor license who has not provided evidence of the following: evidence to the  Commissioner that all employees who will be engaged in mixing, preparing or delivering alcoholic liquor to  to customers, guests, or patrons, have successfully completed a Beverage Alcohol Sellers and Services Education and Training (“BASSETT”) Program conducted by an agency licensed by the Illinois Department of Alcohol and  Substance Abuse or training provided by the insurance company providing coverage to a license holder. Each new  Such employee hired by the licensee after issuance of the license shall complete a BASSETT program at the next  Available training session or within sixty (60) days of actually beginning work, whichever comes first. A copy of  the certificate of completion of such BASSETT program for each such employee shall be filed with the  Commissioner. Each certification shall be renewed every three (3) years from the date of issue. Organizations that  are issued a Class F, Special Event License shall not be required to have their servers trained as set forth above.  Organizers of a Class F Special Event shall meet with designated City Officials to go over standard protocol for  serving alcoholic beverages prior to the event.

LIST OF ALL EMPLOYEES WHO WILL BE ENGAGED IN MIXING, PREPARING, OR DELIVERING ALCOHOLIC LIQUOR TO CUSTOMERS, GUESTS, OR PATRONS

Bassett Training Certificates

Maximum upload size: 104.86MB

Application for City of Geneseo, Illinois Liquor License

Applicant - Corporate Information

Contact Information

Status of Buisness

Ownership Information

Ownership Information

Ownership Information

Business Premises Information

Fee Section

Eligibility Questions

Resident Manger or Sole Proprietor Information

BASSETT TRAINING LIST Per City of Geneseo Liquor Ordinance Section 110.17Q

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