Application for Beer License
Revised December 2015
CITY OF RUGBY
APPLICATION FOR LIQUOR AND/OR BEER LICENSE
To the Honorable Governing Body of the incorporated City ofRugby, in Pierce County, North Dakota:
The undersigned applicant hereby makes application for license to engage in the retail sale of:(please circle)
LIQUOR/WINECLASS A (clubs)ON SALE ONLY$ 200.00
LIQUOR/WINECLASS B (package stores)OFF SALE ONLY$ 250.00
LIQUOR/WINECLASS C (bars) ON & OFF SALE$ 1,100.00
LIQUOR/WINECLASS D (motels/restaurants) ON & OFF SALE$ 1,100.00
LIQUOR/WINECLASS E (restaurants-wine only)ONSALE ONLY$ 200.00
LIQUOR/WINECLASS F (restaurants-liquor/wine) ON SALE ONLY$ 400.00
BEERCLASS A (clubs)ON SALE ONLY$ 200.00
BEERCLASS B (package stores)OFF SALE ONLY$ 250.00
BEERCLASS C (bars) ON & OFF SALE$ 250.00
BEERCLASS D (motels/restaurants) ON & OFF SALE$ 250.00
BEERCLASS E (restaurants)ON SALE ONLY$ 200.00
SUNDAY OPENING(Permit Application Attached)ON-OFF-ON & OFF$ 25.00
Said premises hereinafter described, and as a basis therefore makes the following assertions:
1. Name of applicant ______DOB______Age ______
Citizenship ______Place of residence ______
For how long have you been a resident of the State of North Dakota? ______
2.State whether incorporated ______If so, in what State incorporated? ______
Date of charter ______Name and address of each officer: ______
______
______
3. State whether this is a partnership ______.
If so, state name, citizenship, and place of residence of each partner:
______
______
______
4. In what business are you now engaged? ______
Businessaddress: ______
5. Description of premises for which license is desired: ______floor of buildinglocated on lot ______
in block ______in ______Addition to said City.
Street Address is: ______
6. Have you pleaded guilty to or been convicted of a crime?______
If so what crime? ______
In what Court? ______When?______
7. Will you personally conduct the business on premises hereinbefore described and for which license is applied?______. If not, state name, age, citizenship and place of residence of person who will be in charge thereof. ______
8. Have you received a license to engage in the retail sale of liquor/beer at said premises from the Federal Government? ______When issued ______Number of license ______
9. Have you received a license to engage in the retail sale of beer off of (and on) said premises from State of North Dakota? ______When issued? ______Number of license ______
10. Do you promise and agree not to permit the violation of any law of the State of North Dakota on said premises? ______
11. Do you promise and agree to abide by each provision of Ordinance 8.04&/or 8.08 passed by the governing body of said City on the 24th day of June, 1942, and of any future amendments thereto?______
12. Do you promise and agree not to sell or permit the sale of beer on said premises to a minor, incompetent person, or a person who is an inebriate or habitual drunkard, or to any one thereof? ______
13. Do you understand that any license granted upon this application will not be transferable except by specific authority of said governing body, and will authorize the retail sale of beer as herein applied for only at the place and on the premises designated in this application and in such license?______
The applicant herein does hereby consent that the Mayor, and any police officer of the City of Rugby aforesaid, or any person or persons duly authorized by the City Councilof said City may enter upon the premises described in this application at any hour of the day or night, and that they and any one of them shall have free access to the said described premises and every part thereof for the purpose of inspecting the said premises and the records of this applicant relating to the purchase and sale of beer, and applicant does hereby waive any and all rights that he may have under the Constitution of the United States and the Constitution of the State of North Dakota relative to searches and seizures without issuance of a search warrant, and the applicant does hereby agree that such immunities shall never be claimed by him, and that such search, seizure, and inspection may be made at any time without a search warrant. Do you agree to each provision of the above paragraph? YES NO
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Signature of ApplicantDate
STATE OF NORTH DAKOTA
COUNTY OFPIERCE
______being first duly sworn, deposes and says that he/she is the applicant who is described herein and who executed the foregoing and above application, that he/she has read each question and statement therein contained and knows the contents thereof, and that he/she has made the answers set forth in said application, and that each one of said answers is true of his/her own knowledge.
Subscribed and sworn to before me on this ______day of ______, 20 _____
______
(Seal) Notary Public, North Dakota
My commission expires ______