MIXED BEVERAGE LICENSE APPLICATION CHECKLIST Form-Mixed Beverage Application... · MIXED BEVERAGE...

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ALCOHOLIC BEVERAGE LAWS ENFORCEMENT COMMISSION 3812 N. Santa Fe, Suite 200 Oklahoma City, OK 73118 (405) 521-3484 MIXED BEVERAGE LICENSE APPLICATION CHECKLIST Before completing the application packet read the information below: • The building location must be completely constructed or within 60 days of completion of construction in order to apply for a license. Both the application pages and additional items required must all be completed and provided for filing or the application will not be accepted (only exception; the certificate of compliance can be provided prior to license issuance). • The application will be reviewed and under investigation upon filing of application. • The license fee is due upon filing the application. We accept cash, credit card, business check, money order, or cashier’s check for walk-in customers. Mail-in customers can submit the license fee by money order, cashier’s check, or business check only. • File the completed application in person or by mail at the ABLE Commission, 3812 N. Santa Fe Avenue, Suite 200, Oklahoma City, OK 73118, Monday thru Friday 7:30 am to 4:30 pm. • Contact the ABLE Commission office at (405) 521-3484 or visit our website at www.able.ok.gov for questions or general information. Additional items an individual sole proprietor must provide: • A Certificate of Liability Insurance showing coverage for both bodily injury and property damage. • A deed, lease, management agreement, or sales contract in the individual’s name. • A Certificate of Compliance from the city or county where the business is located stating all building codes for zoning, fire, safety, and health are in compliance or are not required. • A Tax Statement from the County Treasurer’s office stating no real or personal property taxes are owed for the individual. ADDITIONAL ITEMS FOR CORPORATIONS, LIMITED LIABILITY COMPANIES, PARTNERSHIPS AND TRIBES OR TRIBAL CORPORATIONS ARE LISTED UNDER THEIR RESPECTIVE SECTIONS IN THE FOLLOWING APPLICATION.

Transcript of MIXED BEVERAGE LICENSE APPLICATION CHECKLIST Form-Mixed Beverage Application... · MIXED BEVERAGE...

Page 1: MIXED BEVERAGE LICENSE APPLICATION CHECKLIST Form-Mixed Beverage Application... · MIXED BEVERAGE LICENSE APPLICATION CHECKLIST Before completing the application packet read the information

ALCOHOLIC BEVERAGE LAWSENFORCEMENT COMMISSION

3812 N. Santa Fe, Suite 200Oklahoma City, OK 73118

(405) 521-3484

MIXED BEVERAGE LICENSE APPLICATION CHECKLISTBefore completing the application packet read the information below:

•Thebuildinglocationmustbecompletelyconstructedorwithin60daysofcompletionofconstruction inordertoapplyforalicense.

•Both the application pages and additional items required must all be completed and provided forfilingortheapplicationwillnotbeaccepted(onlyexception;thecertificateofcompliance can be provided prior to license issuance).

•Theapplicationwillbereviewedandunderinvestigationuponfilingofapplication.

•The license fee is due upon filing the application.We accept cash, credit card, business check, moneyorder,orcashier’scheckforwalk-incustomers.Mail-incustomerscansubmitthelicensefee bymoneyorder,cashier’scheck,orbusinesscheckonly.

•File the completed application in personor bymail at theABLECommission, 3812N.SantaFe Avenue,Suite200,OklahomaCity,OK73118,MondaythruFriday7:30amto4:30pm.

•ContacttheABLECommissionofficeat(405)521-3484orvisitourwebsiteatwww.able.ok.govfor questionsorgeneralinformation.

Additional items an individual sole proprietor must provide:•ACertificateofLiabilityInsuranceshowingcoverageforbothbodilyinjuryandpropertydamage.

•Adeed,lease,managementagreement,orsalescontractintheindividual’sname.

•ACertificateofCompliancefromthecityorcountywherethebusinessislocatedstatingallbuilding codesforzoning,fire,safety,andhealthareincomplianceorarenotrequired.

•ATaxStatement fromtheCountyTreasurer’sofficestatingnorealorpersonalproperty taxesare owedfortheindividual.

ADDITIONAL ITEMS FOR CORPORATIONS, LIMITED LIABILITY COMPANIES, PARTNERSHIPS AND TRIBES OR TRIBAL CORPORATIONS ARE LISTED UNDER THEIR

RESPECTIVE SECTIONS IN THE FOLLOWING APPLICATION.

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Page1ABLE Form #MXB-1 Revised 03/18

BUSINESS OWNERSHIP INFORMATION

ALCOHOLIC BEVERAGE LAWSENFORCEMENT COMMISSION

3812 N. Santa Fe, Suite 200Oklahoma City, OK 73118

(405) 521-3484

MIXED BEVERAGE LICENSE APPLICATIONPleasecompletetheentireform.NolicenseswillbeissuedunlesstheABLECommissionisabletoverifytheinformationprovided.TheABLECommissionmayrequestadditionalinformationnotrequestedonthisapplication.Additionalinformationmayberequiredpriortotheissuanceofanylicense.

MIXED BEVERAGE LICENSES AND FEES

2. DBA Name of Location

3. Location Address

4. Mailing Address

City

5. Business Phone Number 6. Alternate Phone Number 7. E-mail Address

City

County

County

State

State

Zip

Zip

MixedBeverageLicense-$1530

1.PrimaryBusinessatthisLocation

cRestaurant cBar/Club cMotionPictureTheater cEventCenter

cCasino cEntertainmentVenue cGolf&CountryClub cOther_________________________

8. TypeofOwner

cIndividual cPartnership cLimitedPartnership cGeneralPartnership cCorporation

cLimitedLiabilityCompany cTribe cTribalCorporation/Entity cOther__________________________

9a. NameofIndividual/SoleProprietor(ifownedbyanindividual) 9b. SocialSecurityNumber

10b.FederalEmployerIdentification#10a.NameofBusinessEntity(ifPartnership,Corp.,LLCorTribe)

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Page2ABLE Form #MXB-1 Revised 03/18

BUSINESS OWNERSHIP INFORMATION

12. Application Contact Person

Application Contact Address

Application Contact Phone Number Application Contact E-Mail Address

13. Name of General Manager Onsite General Manager Phone Number

11.WasPremisesPreviouslyLicensedbytheCommission

cYes cNo

If Yes, to Whom? TypeofLicense

15a.Wheredidyourfundingforthisbusinessoriginate?Check and list all that apply.

INVESTMENT TYPE AMOUNT INVESTMENT TYPE AMOUNT

cOngoingBusinessFunds $ cCash/PersonalFunds $

cPromissoryNote $ cServices $

cLoan $ cEquipment $

cGift $ cOperatingCapital $

cOther $

14.Isyourbusinesslocatedwithin300feetofachurchorpublicschool?

cYes cNo

I,_________________________________,beingdulyswornuponoathdeposesandsays:Thathe/sheistheapplicantwhomakestheaboveandforegoingapplication,thathe/shehasreadandsignedthesame;knowsthecontentsthereofandthatallstatementsthereincontainedaretrue.Applicant(s)certifiesthatthestatementsandrepresentationsmadehereinaretrueandcorrectandconsentsthatifanystatementsandrepresentationshereinarefoundtobefalseoromitted,thattheDirectormayrefusetoissuesaidlicenseormaycausesuchlicensetoberevokedforthwithatanytime.He/Shefurtheragreesthathe/shehasfiledallappropriatepropertywiththeCountyAssessorandthatalladvaloremtaxesassessedonhis/herproperty,bothrealandpersonal,andwhereversituated in thestateofOklahoma,havebeenpaid.

_________________________________________________ SignatureofApplicant(s)

15b.Whomorwheredidtheinitialinvestmentcomefrom?ex. Bank, family owned operation, line of credit, investment type, etc.

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Page3ABLE Form #MXB-1 Revised 03/18

CORPORATE OWNERSHIP INFORMATION

CORPORATION / NON PROFIT ORGANIZATIONCorporationsmustcompletethissectionandprovidethefollowingitems:

•ACertificateofGoodStandingfromtheOklahomaSecretaryofState.Contact(405)521-4211

•ACertificateofIncorporationfromtheSecretaryofState.

•AcopyofMinutesElectingCorporateOfficers,Directors,Stockholders,andapplyingfora license withABLE.

•ACertificateofLiabilityInsuranceshowingcoverageforbothbodilyinjuryandpropertydamage.

•Adeed,lease,managementagreement,orsalescontractinthenameoftheCorporation.

•ACertificateofCompliancefromthecityorcountywherethebusinessislocatedstatingallbuilding codesforzoning,fire,safety,andhealthareincomplianceornotrequired.

•ATaxStatement fromtheCountyTreasurer’sofficestatingnorealorpersonalproperty taxesare owedfortheCorporation.

•Notforprofit&501(c)(3)organizationsareonlyrequiredtolistOfficers,notDirectorsorStockholders.

•OnlyStockholdersowning15%ormorearerequiredtobereportedforCorporations.

SSNorFEI#

SSNorFEI#

SSNorFEI#

Drivers License No./State

Drivers License No./State

Drivers License No./State

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

No. of Shares

No. of Shares

No. of Shares

cOfficer cDirectorcStockholder cTrustee/Beneficiary

cOfficer cDirectorcStockholder cTrustee/Beneficiary

cOfficer cDirectorcStockholder cTrustee/Beneficiary

Title

Title

Title

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

1.FederalEmployerIdentificationNumber

2.BusinessEntityName

3. No. of Shares Authorized to Issue No. of Shares Issued No. of Shares Unissued

4. Service Agent Service Agent Address

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Page4ABLE Form #MXB-1 Revised 03/18

CORPORATE OWNERSHIP INFORMATION (continued)

SSNorFEI#

SSNorFEI#

SSNorFEI#

SSNorFEI#

SSNorFEI#

SSNorFEI#

SSNorFEI#

Drivers License No./State

Drivers License No./State

Drivers License No./State

Drivers License No./State

Drivers License No./State

Drivers License No./State

Drivers License No./State

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

No. of Shares

No. of Shares

No. of Shares

No. of Shares

No. of Shares

No. of Shares

No. of Shares

cOfficer cDirectorcStockholder cTrustee/Beneficiary

cOfficer cDirectorcStockholder cTrustee/Beneficiary

cOfficer cDirectorcStockholder cTrustee/Beneficiary

cOfficer cDirectorcStockholder cTrustee/Beneficiary

cOfficer cDirectorcStockholder cTrustee/Beneficiary

cOfficer cDirectorcStockholder cTrustee/Beneficiary

cOfficer cDirectorcStockholder cTrustee/Beneficiary

Title

Title

Title

Title

Title

Title

Title

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

IF YOU NEED MORE SPACE USE ADDITIONAL COPIES OF THIS PAGE

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Page5ABLE Form #MXB-1 Revised 03/18

LIMITED LIABILITY COMPANY OWNERSHIP INFORMATION

LIMITED LIABILITY COMPANY

1.FederalEmployerIdentificationNumber

2.BusinessEntityName

SSNorFEI#

SSNorFEI#

SSNorFEI#

Drivers License No./State

Drivers License No./State

Drivers License No./State

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

% Membership or Units

% Membership or Units

% Membership or Units

cManagercMember

cManagercMember

cManagercMember

Title

Title

Title

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

3. No. of Memberships or Units Issued 4. Member Managed or Manager Managed

cMemberManaged cManagerManaged

5. Resident Agent Name

Resident Agent Address

LimitedLiabilityCompaniesmustcompletethissectionandprovidethefollowingitems:

•ACertificateofGoodStandingfromtheOklahomaSecretaryofState.Contact(405)521-4211

•AcopyoftheArticlesofOrganizationfiledwiththeSecretaryofState.

•A copy of LLCOperatingAgreement including the schedule or attachment showingmembership interest.

•ACertificateofLiabilityInsuranceshowingcoverageforbothbodilyinjuryandpropertydamage.

•Adeed,lease,managementagreement,orsalescontractinthenameoftheLLC.

•ACertificateofCompliancefromthecityorcountywherethebusinessislocatedstatingallbuilding codesforzoning,fire,safety,andhealthareincomplianceornotrequired.

•ATaxStatement fromtheCountyTreasurer’sofficestatingnorealorpersonalproperty taxesare owedfortheLLC.

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Page6ABLE Form #MXB-1 Revised 03/18

LIMITED LIABILITY COMPANY OWNERSHIP INFORMATION (continued)

IF YOU NEED MORE SPACE USE ADDITIONAL COPIES OF THIS PAGE

SSNorFEI#

SSNorFEI#

SSNorFEI#

SSNorFEI#

SSNorFEI#

SSNorFEI#

SSNorFEI#

Drivers License No./State

Drivers License No./State

Drivers License No./State

Drivers License No./State

Drivers License No./State

Drivers License No./State

Drivers License No./State

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

% Membership or Units

% Membership or Units

% Membership or Units

% Membership or Units

% Membership or Units

% Membership or Units

% Membership or Units

cManagercMember

cManagercMember

cManagercMember

cManagercMember

cManagercMember

cManagercMember

cManagercMember

Title

Title

Title

Title

Title

Title

Title

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

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Page7ABLE Form #MXB-1 Revised 03/18

PARTNERSHIP INFORMATION

PARTNERSHIP

1.FederalEmployerIdentificationNumber

2.BusinessEntityName

3. Service Agent Service Agent Address

SSNorFEIN#

SSNorFEI#

SSNorFEI#

SSNorFEI#

Drivers License No./State

Drivers License No./State

Drivers License No./State

Drivers License No./State

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

% of Interest

% of Interest

% of Interest

% of Interest

cGeneralPartnercLimitedPartner

cGeneralPartnercLimitedPartner

cGeneralPartnercLimitedPartner

cGeneralPartnercLimitedPartner

Title

Title

Title

Title

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Partnerships, Limited Partnerships or General Partnerships must complete this section and providethefollowingitems:

•ACertificateofPartnershipfromtheOklahomaSecretaryofState.Contact(405)521-4211

•AcopyofthePartnershipAgreementlistingallpartnersandtheamountofinteresteachpartnerowns.

•ACertificateofLiabilityInsuranceshowingcoverageforbothbodilyinjuryandpropertydamage.

•Adeed,lease,managementagreement,orsalescontractinthenameofthePartnership.

•ACertificateofCompliancefromthecityorcountywherethebusinessislocatedstatingallbuilding codesforzoning,fire,safety,andhealthareincomplianceornotrequired.

•ATaxStatement fromtheCountyTreasurer’sofficestatingnorealorpersonalproperty taxesare owedforeachpartner.

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Page8ABLE Form #MXB-1 Revised 03/18

PARTNERSHIP INFORMATION (continued)

SSNorFEI#

SSNorFEI#

SSNorFEI#

SSNorFEI#

SSNorFEI#

SSNorFEIN#

SSNorFEI#

Drivers License No./State

Drivers License No./State

Drivers License No./State

Drivers License No./State

Drivers License No./State

Drivers License No./State

Drivers License No./State

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

Birthdate(mm/dd/yyyy)

% of Interest

% of Interest

% of Interest

% of Interest

% of Interest

% of Interest

% of Interest

cGeneralPartnercLimitedPartner

cGeneralPartnercLimitedPartner

cGeneralPartnercLimitedPartner

cGeneralPartnercLimitedPartner

cGeneralPartnercLimitedPartner

cGeneralPartnercLimitedPartner

cGeneralPartnercLimitedPartner

Title

Title

Title

Title

Title

Title

Title

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

Last NameFirstNameorEntityName MI

IF YOU NEED MORE SPACE USE ADDITIONAL COPIES OF THIS PAGE

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Page9ABLE Form #MXB-1 Revised 03/18

TRIBE/TRIBAL OWNERSHIP INFORMATION

TRIBE/TRIBAL CORPORATION

1.FederalEmployerIdentificationNumber

2.NameofTribeorTribalEntity

3. Service Agent Service Agent Address

SSNorFEI# Drivers License No./State Birthdate(mm/dd/yyyy)

cTribalCommitteeOfficer

TitleLast NameFirstNameorEntityName MI

SSNorFEI# Drivers License No./State Birthdate(mm/dd/yyyy)

cTribalCommitteeOfficer

TitleLast NameFirstNameorEntityName MI

SSNorFEI# Drivers License No./State Birthdate(mm/dd/yyyy)

cTribalCommitteeOfficer

TitleLast NameFirstNameorEntityName MI

SSNorFEI# Drivers License No./State Birthdate(mm/dd/yyyy)

cTribalCommitteeOfficer

TitleLast NameFirstNameorEntityName MI

Tribes or Tribal Corporations must complete this sectionandprovidethefollowingitems:

•YoumustsubmitacopyofanyexecutedManagementAgreements.

•YoumustsubmitacopyofthetrustdocumentordeedforthepropertyfortheTribeorCorportation.

•Youmustsubmitaletterfromthetribestatingwhetherofnottheyrequirebuildingcodeinspections orstatingthelocationmeetszoning,fire,safety,andhealthcodes.

•Youmustsubmitaletterfromthetribestatingallrealandpersonalpropertytaxeshavebeenpaidor theirtaxstatusistax-exempt.

•YoumustsubmitaletterfromtheIntertribalCommissionapprovingthetribalgamingcompact.

•YoumustsubmitacopyofasignedandcompletedTribalGamingCompact.

•Youmust submit a copy of the tribal rules, regulations, laws, or ordinances related to alcoholic beverages.

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Page10ABLE Form #MXB-1 Revised 03/18

TRIBE/TRIBAL OWNERSHIP INFORMATION (continued)

IF YOU NEED MORE SPACE USE ADDITIONAL COPIES OF THIS PAGE

SSNorFEI# Drivers License No./State Birthdate(mm/dd/yyyy)

cTribalCommitteeOfficer

TitleLast NameFirstNameorEntityName MI

SSNorFEI# Drivers License No./State Birthdate(mm/dd/yyyy)

cTribalCommitteeOfficer

TitleLast NameFirstNameorEntityName MI

SSNorFEI# Drivers License No./State Birthdate(mm/dd/yyyy)

cTribalCommitteeOfficer

TitleLast NameFirstNameorEntityName MI

SSNorFEI# Drivers License No./State Birthdate(mm/dd/yyyy)

cTribalCommitteeOfficer

TitleLast NameFirstNameorEntityName MI

SSNorFEI# Drivers License No./State Birthdate(mm/dd/yyyy)

cTribalCommitteeOfficer

TitleLast NameFirstNameorEntityName MI

SSNorFEI# Drivers License No./State Birthdate(mm/dd/yyyy)

cTribalCommitteeOfficer

TitleLast NameFirstNameorEntityName MI

SSNorFEI# Drivers License No./State Birthdate(mm/dd/yyyy)

cTribalCommitteeOfficer

TitleLast NameFirstNameorEntityName MI

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Page11ABLE Form #MXB-1 Revised 03/18

RESIDENTIAL ADDRESS

RESIDENT STATUS

APPLICANT

5.SocialSecurityNumber 6. Drivers License No. / State 7.PlaceofBirth(City,State,Country)

8.Sex 9. Height 10. Weight 12.EyeColor11. Hair Color

13. Home Phone 14. Business Phone

15. Email Address

16.Listresidentialaddressesforthepast(5)yearsstartingwiththecurrentaddress.Attachaseparatesheet ifnecessary.

17a.AreyouaU.S.Citizen?

cYes cNo

17c. If “Naturalized” provide the “A” number? 17d.If“NO”whatisyourlegalstatusintheU.S.?

17b.If“Yes”,answerthefollowing

cNativeBorn cNaturalized

4.Birthdate(mm/dd/yyyy)3. Last Name1. First Name 2. MI

NUMBER AND STREET CITY, STATE, ZIP FROM(mm/yyyy) TO(mm/yyyy)

INDIVIDUAL PERSONAL HISTORYMUST BE COMPLETED BY ALL APPLICANTS:

Individuals,partners,corporateofficers,directors,stockholders,LLCmanagers,LLCmembers, tribal members, trustees, etc.

•Pleasecompleteallfieldsandanswerallquestions.

•AnyfalsestatementwilldisqualifyyouandsubjectyoutoprosecutionunderOklahomaStatelaw.

CURRENT EMPLOYMENT18a.NameofEmployer

Title

Employer’sAddress

From(mm/yyyy) To(mm/yyyy)

17e.ProvidealldocumentssuchasVisa,ResidentAlienorEmploymentAuthorizationDocuments

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Page12ABLE Form #MXB-1 Revised 03/18

INDIVIDUAL QUESTIONNAIRE

19e.Ifyouhaveanswered“Yes”to19athrough19d,listbelow

OFFENSE DATE CITY/COUNTY STATE DISPOSITION(fine,probation,incarceration)

20.Areyoupresentlyorhaveyoubeenlicensedoremployedintheliquorbusiness?

cYes cNo

LICENSE TYPE LICENSE NUMBER WHEN LOCATION

21.Haveyoueverreceivedawarning,anoticeofviolation,suspension,fineorrevocationasalicensee?

cYes cNo

WHEN LOCATION

22.Haveyoueverbeenrefusedalicensetosell,serveordispensealcoholicbeverages?

cYes cNo

WHEN LOCATION

23.Haveyoueverheldordoyouholdanyfinancialinterestinanyliquorenterprise(manufacturing,importing, wholesaleorretail)?

cYes cNoWHEN LOCATION

19b.Haveyoubeenconvictedofanycrime,violationorinfractionofanylaw?

cYes cNo

19c.Aretherepresentlypendingagainstyouanycriminalcharges?

cYes cNo

19a.Haveyoueverbeenconvictedof,pledguiltytoornolocontendretoafelony?

cYes cNo

19d.Haveyoueverbeenconvictedofaviolationofanystateorfederallawrelatingtoalcoholicbeverages,or forfeitedanybondwhileanysuchchargewaspendingagainstyou?

cYes cNo

24a.Isyourspouseoranyfamilymember(s)workinginanyareaoftheliquorindustry?

cYes cNo

24b.Ifyes,forwhom?

25a.Areyouamemberofanyboardorcommission,oranagentoranemployeeofthestateofOklahomaorany politicalsubdivisionthereof?(County,City,TownorSchoolDistrict)

cYes cNo

25b.Ifyes,explain

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Page13ABLE Form #MXB-1 Revised 03/18

INDIVIDUAL QUESTIONNAIRE (continued)

27a.Doesyourinterestresultinexerciseofcontrolover,orparticipationinthemanagementofthe manufactureorwholesaler’sbusinessorbusinessdecisions?

cYes cNo

26a.Doyouindividually,orthelegalentitytobelicensed,haveanyright,title,lien,claimorotherinterest, financialorotherwise,in,uponortothepremises,equipment,businessofanyABLECommissionLicense?

cYes cNo

28a.Areyoualawenforcementofficial,apeaceofficerengaginginlawenforcementactivitiesorapersonwho appointslawenforcementofficials?

cYes cNo

26b.Ifyes,explain

27b.Ifyes,explain

28b.Ifyes,explain

29. AreyouanemployeeoforrelatedtoanymemberoftheABLECommissionortotheDirectororAssistant Directorbyaffinityorconsanguinitywithinthethirddegree?

cYes cNo

30. Areyouajudge,districtattorneyorpublicofficialwhositsinajudicialcapacitywithjurisdictionoverthe OklahomaAlcoholicBeverageControlAct?

cYes cNo

31. AreyouanemployeeoftheOklahomaTaxCommissionengaginginauditing,enforcingorcollectingof alcoholicbeveragetaxes?

cYes cNo

I, _________________________________, under penalty of law, swear that I have read allinformationprovidedinthisdocumentandanyattachmentsandtheinformationistrueandcorrect.Ialsounderstandanyfalsestatementorrepresentationinthisapplicationcanresultinmyapplicationbeingdeniedand/orcriminalchargesbeingfiledagainstme.IalsoauthorizetheABLECommissiontousealllegalmeanstoverifytheinformationprovided.IauthorizeanypersonororganizationlistedinthisapplicationtoprovideinformationaboutmetoanAgentoftheOklahomaAlcoholicBeverageLawEnforcementCommissiononaconfidentialbasis,includingbankandfinancialrecords,criminalhistoryrecords,drivingrecords,taxrecordsandanyotherinformationrelatingtocharacterorfitnessforaliquorlicense.IwillimmediatelynotifytheABLECommissionifaLicensee-Wholesalerconnectionasdescribedinthequestionnaireaboveexistsoriscontemplatedinmybusiness.

_________________________________________________ Signature of Applicant

_________________________________________________ Title

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Page14ABLE Form #MXB-1 Revised 03/18

LOCATION DIAGRAMDraworattachadiagramofthelicensedpremises.Thediagramshouldincludethefollowing:outside dimensions, rooms, doorways, bars and liquor storage areas. DO NOT SUBMIT BLUEPRINTS

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Page15ABLE Form #MXB-1 Revised 03/18

NOTICE OF INTENTION TO APPLY FOR AN ALCOHOLIC BEVERAGE LICENSE

1. Complete in detail2.Copytonewspaperforpublication3.Saidnoticeshallbepublished innot less than2column inches ina legalnewspaperof generalcirculationinthecountyinwhichlicensedpremisesaretobelocated.4.Thenoticewillbetwicepublished,onceeveryeight(8)daysfortwo(2)successiveweeks.5.Submitoriginalwithapplication.

In accordance with Title 37, Section 522 and Title 37A, Section 2-141

_______________________________________________________________________________

_______________________________________________________________________________

a/an_______________________________________________________________herebypublishes

noticeof__________ intention toapplywithinsixtydays from thisdate to theOklahomaAlcoholic

Beverage Laws Enforcement Commission for a Mixed Beverage License under

authority of and in compliance with the said Act: That _________ intend(s), if granted

such license to operate as a Mixed Beverage establishment with business premises

located at _____________________________________________________________________________

in ___________________, ___________________, Oklahoma under the business name of

__________________________________________________________________________________

Datedthis_________________________dayof_______________________________,20_______

Signature of applicant(s): if partnership, all partners must sign. If corporation, an officerof the corporation must sign. If limited liability company, a manager must sign. If tribe, atribalmembermustsign.

________________________________ ________________________________

________________________________ ________________________________

Countyof___________________,Stateof___________________

Beforeme,theundersignednotarypublic,personallyappeared:

______________________________________________________________________________to me known to be the person(s) described in and who executed the foregoing application and

acknowledgedthat_____________executedthesameas_____________freeactanddeed.

____________________________________________________________

nameandaddressofindividual,partners,limitedpartnership,corporation,limitedliabilitycompany,tribeortribalcorporation

city county

individual,partnership,limitedpartnership,corporation,limitedliabilitycompany,tribeortribalcorporation

his,her,its,their

he,she,it,they

he,she,they

NotaryPublic Mycommissionexpires

his,her,their

Page 17: MIXED BEVERAGE LICENSE APPLICATION CHECKLIST Form-Mixed Beverage Application... · MIXED BEVERAGE LICENSE APPLICATION CHECKLIST Before completing the application packet read the information

Page16ABLE Form #MXB-1 Revised 03/18

I do hereby declare, under penalty of perjury, that ______________________________________

did cause to be published in a legal newspaper of general circulation in the county

of ___________________ located in the city of ______________________,Oklahoma by causing

the same to be published on the _______ day of ____________________, 20________ and on

the _______ day of ____________________, 20________, a notice of intention to apply for an

ABLECommissionLicense,andthatatruecopyofsaidnoticeisattachedandmadeaparthereof.

________________________________________

Subscribedandsworntobeforemethis_______dayof____________________,20______.

____________________________________________________________

1.Attachacopyofeachrunofthepublication.2.Submitoriginalcompletedproofofpublicationwithapplication.3.Youmaysubmitthepublisher’saffidavitforminplaceoftheaboveaffidavit.

Nameoflegalnewspaper

Legalrepresentativeofthenewspaper

PROOF OF PUBLICATION

NotaryPublic Mycommissionexpires