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Applications must be returned COMPLETE with attachments and supporting documentation. Please check your submission for the following:
Initial each item acknowledging that the required item is included in your packet.
*If requesting a "Package Sales" license, also provide a scale drawing showing distances to any nearby Churches, Schools or Rehab Center. Or furnish certificate of Registered Surveyor that location complies with Ordinances.
OFFICE USE ONLY
Reviewed By: ____________________________________________ Date: _________________________________ Agent for Board of Commissioners
Check all that apply.
BUSINESS REQUESTING LICENSE
If it is a Corporation/Partnership enter the Name and Address of Registered Agent.
If so, list the Name, Business Address, and Percent of Interest for each person, firm or corporation having any interest in this business.
Name(s) and Address(es) of Owner(s) of Building and Property
This pages cannot be completed online. It must be completed in ink.
I, ____________________________________________________________, do solemnly swear, subject to the penalties of false swearing, that the statements and answers made by me as the applicant in the foregoing Alcoholic Beverage Application are true.
I, ___________________________________________________________, hereby acknowledge that I have read and understand the Greene County Alcoholic Beverage Ordinance and that I have received copies of these Ordinances.
I, ____________________________________________________________, acknowledge that I am aware and understand that as a licensee I will be liable for any violations of either the Greene County Alcohol Ordinances or the laws of the state of Georgia, by myself, my employees, associates, partners or other person or entity affiliated with the licensed operation.
In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16- 10-20, and face criminal penalties allowed by such statute.
Executed on the
__________ DAY OF ________________________________, 20_______.
in _________________________________ .
SUBSCRIBED AND SWORN BEFORE ME
ON THIS THE _________ DAY OF ________________________________, 20_______.
My Commission Expires: _________________________
OTHER FINANCIAL INTERESTS
Maiden name, names by former marriages, former names changed legally or other wide, aliases, nicknames, etc.
Other Name Used
marriage, alias, nickname, etc.
Start Date thru End Date
Above Elementary , please provide the following:
Most recent first., if self-employed, give details.
Start to End
PLACES OF RESIDENCY
Most recent first.
Three personal references NOT relatives, former employers, fellow employees or school teachers who have now you well during the past five years.
Do not include traffic violations.
Evidence of Indebtedness
Include in your packet a copy of note(s) or other evidence of indebtedness with all amendments.
* indicates a required field