clerkdept@greenfieldwi.us

7325 W Forest Home Ave Greenfield, WI 53220

Renewal Alcohol Beverage License Application (Submit to municipal clerk)

For the license period beginning and ending:

July 1, yyyy *

June 30, yyyy *

To the Governing Body of the City of Greenfield, County of Milwaukee

Type of License Requested

Class A beer

Class B beer

Class C wine

Class A liquor

Class A liquor (cider only)

Class B liquor

Reserve Class B liquor

Class B (wine only) winery

Wisconsin Seller's Permit Number

FEIN Number

Choose which type of legal entity your business is:

Individual

Limited Liability Company

Partnership

Corporation/Nonprofit Organization

Full Name (Last, First, Middle Name)

Home Address (Street, City & Zip Code)

Full Name (Last, First, Middle Name)

Home Address (Street, City & Zip Code)

Full Name (Last, First, Middle Name) (n/a if none)

Home Address (Street, City & Zip Code) (n/a if none)

Full Name (Last, First, Middle Name) (n/a if none)

Home Address (Street, City & Zip Code) (n/a if none)

Full legal Name of Corporation/Nonprofit Organization/Limited Liability Company

Address of Corporation/Limited Liability Company (if different from licensed premises)

Full legal Name of Corporation/Nonprofit Organization/Limited Liability Company

Address of Corporation/Limited Liability Company (if different from licensed premises)

All corporations/organizations or limited liability companies applying for a license to sell fermented malt beverages and/or intoxicating liquor must appoint an agent. Agent Name (Last, First, Middle)

Home Address (Street, City or Post Office, & Zip Code)

All corporations/organizations or limited liability companies applying for a license to sell fermented malt beverages and/or intoxicating liquor must appoint an agent. Agent Name (Last, First, Middle)

Home Address (Street, City or Post Office, & Zip Code)

President/Member Name (Last, First, Middle) (n/a if none)

Home Address (Street, City or Post Office, & Zip Code) (n/a if none)

President/Member Name (Last, First, Middle) (n/a if none)

Home Address (Street, City or Post Office, & Zip Code) (n/a if none)

Vice President/Member Name (Last, First, Middle) (n/a if none)

Home Address (Street, City or Post Office, & Zip Code) (n/a if none)

Vice President/Member Name (Last, First, Middle) (n/a if none)

Home Address (Street, City or Post Office, & Zip Code) (n/a if none)

Secretary/Member Name (Last, First, Middle) (n/a if none)

Home Address (Street, City or Post Office, & Zip Code) (n/a if none)

Secretary/Member Name (Last, First, Middle) (n/a if none)

Home Address (Street, City or Post Office, & Zip Code) (n/a if none)

Treasurer/Member Name (Last, First, Middle) (n/a if none)

Home Address (Street, City or Post Office, & Zip Code) (n/a if none)

Treasurer/Member Name (Last, First, Middle) (n/a if none)

Home Address (Street, City or Post Office, & Zip Code) (n/a if none)

Directors/Managers Name (Last, First, Middle) (n/a if none)

Home Address (Street, City or Post Office, & Zip Code) (n/a if none)

Directors/Managers Name (Last, First, Middle) (n/a if none)

Home Address (Street, City or Post Office, & Zip Code) (n/a if none)

Directors/Managers Name (Last, First, Middle) (n/a if none)

Home Address (Street, City or Post Office, & Zip Code) (n/a if none)

Directors/Managers Name (Last, First, Middle) (n/a if none)

Home Address (Street, City or Post Office, & Zip Code) (n/a if none)

Trade Name of business

Business Phone Number

Address of Premises

City & Zip Code

Does the applicant understand that they must purchase alcohol beverages only from Wisconsin wholesalers, breweries and brewpubs?

Yes

No

Premises description: Describe building or buildings where alcohol beverages are to be sold and stored. The applicant must include all rooms including living quarters, if used, for the sales, service, consumption, and/or storage of alcohol beverages and records. (Alcohol beverages may be sold and stored only on the premises described.)

Legal description (omit if street address is given above):

Since filing of the last application, has the named licensee, any member of a partnership licensee, or any member, officer, director, manager or agent for either a limited liability company licensee or nonprofit organization licensee been convicted of any offenses (excluding traffic offenses not related to alcohol) for violation of any federal laws, any Wisconsin laws, any laws of other states, or ordinances of any county or municipality?

Yes

No

If yes, list the following for each instance: Name, charge, where convicted, date, penalty

Conviction type:

Misdemeanor

Felony

Are charges for any offenses presently pending (excluding traffic offenses not related to alcohol) against the named licensee or any other persons affiliated with this license?

Yes

No

If yes, list the following for each instance: name, pending charge, date.

Except for the prior question, have there been any changes in the answers to the questions as submitted by you on your last application for this license?

Yes

No

If yes, explain...

Was the profit or loss from the sale of alcohol beverages for the previous year reported on the Wisconsin Income or Franchise Tax return of the licensee?

Yes

No

If not, explain...

Does the applicant understand they must hold a Wisconsin Seller's Permit? [phone 608-266-2776]

Yes

No

Upload a copy of your Wisconsin Seller's Permit.

Click Here to Upload

Does the applicant understand that alcohol beverage invoices must be kept at the licensed premises for 2 years from the date of invoice and made available for inspection by law enforcement?

Yes

No

Is the applicant indebted to any wholesaler beyond 15 days for beer or 30 days for liquor?

Yes

No

Does the applicant owe municipal property taxes, assessments or other fees? (Note: Renewal of licenses may be denied pursuant to a local ordinance, if the licensee owes municipal taxes, assessments or other fees).

Yes

No

READ CAREFULLY BEFORE SIGNING: Under penalty provided by law, the undersigned states that each of the above questions has been truthfully answered to the best of the knowledge of the signer. The signer agees that he/she is the person named in the foregoing application; that the applicant has read and made a complete answer to each question, and that the answers in each instance are true and correct. The undersigned further understands that any license issued contrary to Chapter 125 of the Wisconsin Statutes shall be void, and under penalty of state law, the applicant may be prosecuted for submitting false statements and affidavits in connection with this application. Any person who knowingly provides materially false information on this application may be required to forfeit not more than $1,000.

Contact Person's Full Name

Title/Member

Today's Date

Date Picker

Signature

First Name

Last Name

Email

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Phone Number of Contact Person

Email of Contact Person