Liquor License Application Form
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1Mandeville LA Occupational Chain Store License Renewal
c/o RDS
9618 Jefferson Highway, Suite D #334
Baton Rouge, LA 70809
Phone 800-556-7274
Liquor License Application
1. Liquor license to be issued to:__________________________________________________________________________________
2. Legal name(s): Individual, Partners, or Corporation _________________________________________________________________
3. Apply for: Class “A”___ Class “B”____/ High Content____ Low Content____/Restaurant____
4. Business location address: __________________________________________ ___________________ ___________ __________
Address
City
State
Zip
Telephone (____) _____________________________________________________________________________________
5. Mailing address __________________________________________________ ___________________ ____________ ________
Address
City
State
Zip
6. Contact Person____________________________________________Phone Number (____) __________________
E-Mail Address: ___________________ Fax Number (____) ________________Web Address _____________________
7. Type of organization: _Individual (Complete line A only) __ Partnership _ Corporation __ Non-Profit __ LLP __ LLC ___ Other
8. If a Corporation, LLC, LLP, or Partnership, supply name, title, social security #, home address and telephone # of all officers,
members, managers, partners, agents or other representative. The list of names below should each furnish a notarized Schedule “A”.
A. _________________________________________ _________________________ ________________ ___________
Name
Title
SSN
% Owned
___________________________________________________ ___________________ ______ ______ _____________
Resident Address
City
State
Zip
Home Phone Number
B. _________________________________________ _________________________ ________________ ___________
Name
Title
SSN
% Owned
___________________________________________________ ___________________ ______ ______ _____________
Resident Address
City
State
Zip
Home Phone Number
C. _________________________________________ _________________________ ________________ ___________
Name
Title
SSN
% Owned
___________________________________________________ ___________________ ______ ______ _____________
Resident Address
City
State
Zip
Home Phone Number
9. Is this application by a new owner to take over an existing business that has been selling liquor regularly and
continuously to the present time? _______ If yes, list.
__________________________ _________________________ ________________________________ ___________
Trade name
Owner=s name
Address
License #
10. Does applicant hold State or City of Mandeville liquor license for current year at any other location?
________ If yes: Name______________________ Location: __________________________
11. Has applicant applied for state liquor license? ________
12. Has the applicant ever been denied a state or local liquor license? ________
13. Is premise located in an area where the sale of liquor is prohibited by local or state laws? ____
14. Is applicant the owner of the premises to be occupied? ________
If no, does applicant hold a bona fide written lease? ________ (Supply copy of lease with application.)
15. If premises leased, give name and address of lesser.____________________________________________________
16. Describe the part of the building to be occupied by business:___________________________
17. Open date for this location _____________________________________________________
18. Describe in detail your business. i.e.: Type of sales, activity, or service you perform:
_________________________________________________________________________________________________
An original approved Sales Tax Clearance Certificate must be attached to the application, requested from the St. Tammany
Parish Sales Tax Department. Visit for forms and to register online.
I affirm that the information given on this application is true and correct.
Signature of Applicant _______________________________________ Title: ___________________
Signature of Preparer__________________________________________Date___________________
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