APPLICATION FOR LICENSE TO SERVE FERMENTED MALTED BEVERAGES AND

application for license to serve fermented malted beverages and intoxicating liquors to the town board of the town of oconomowoc, county o

APPLICATION FOR LICENSE TO SERVE FERMENTED MALTED
BEVERAGES AND INTOXICATING LIQUORS
To the Town Board of the Town of Oconomowoc, County of Waukesha:
I hereby apply for a License to serve, from date hereof to June 30,
2022, inclusive (unless sooner revoked), Fermented Malt Beverages and
Intoxicating Liquors, subject to the limitations imposed by Section
125 of Wisconsin Statues and local Ordinances and all acts amendatory
thereof and supplementary thereto, and hereby agree to comply with all
laws, resolutions, ordinances and regulation, Federal, State or Local,
affecting the sale of such beverages and liquors if a license be
granted to me.
ANSWER THE FOLLOWING QUESTIONS FULLY AND COMPLETELY. PLEASE PRINT
Name of Applicant
-----------------
First Middle Last
STREET ADDRESS of Applicant
Street City State, Zip
MAILING ADDRESS (if different)
Street City State, Zip
Phone Number ( ) - - Date of Birth / /
Driver’s License #____________________________ I certify that I am
_________ years of age
(Social Security number if no D/L)
Have you ever been convicted of or violated any license law or
ordinance
regulating the sale of beverages or intoxicating liquors? Yes_______
No_______ (if Yes, describe)
Have you ever been convicted of violating any law of the State of
Wisconsin?
(including traffic) Yes_______ No_______ (If Yes, describe)
Have you ever been convicted of a felony? Yes_______ No________ (If
Yes, describe)
Date of such conviction ______________________________ Name of Court
______________________________________
Establishment you will work at in the Town of
Oconomowoc_____________________________________________________________
Establishment’s Phone Number (____________)
-______________-_____________
Have you previously held an Operator’s License in the Town? Yes ____
No _____. If yes, date of expiration June 30, 20_____.
I, _____________________________, being first duly sworn on oath say
that I am the person who made and signed the foregoing application for
an operator’s license; that all the statements made are true.
X____________________________________________ _______________,
20______
==============================================================
(Signature of Applicant) (Date)
**FEE IS NON-REFUNDABLE**
Subscribed and sworn before me this _____ New $35 (school cert.
attached)
_________day of ____________________, 20_______ _____ Renewal
(expired) $30
_____ Renewal (current license) $25
_____________________________________________ _____ Provisional $15
Notary Public, Waukesha County, WI _____ Temporary $5
=====================================================
Photo Required:
Previous License Check: _____________________ Photo Verification: MAIL
OR PICK-UP
________________________________________________________________________________________________________________
Town Board Mtg. date _______________ Date forwarded to Police
_____________ Police Chief Approval __________________