Beer And Liquor License Application Form - Town Of Port Barre, La

RDS--LA Occupational License Tax

9618 Jefferson Highway, Suite D #334

Baton Rouge, LA 70809

Toll Free Phone 800-556-7274

Toll Free Fax Number 844-528-6529

TOWN OF PORT BARRE, LA (1450) BEER AND LIQUOR LICENSE APPLICATION

**If you need to obtain a beer and or liquor license please complete this application and return along

with your occupational license application and payment**

If you no longer sell beer and/or liquor, please return this notice indicating so.

Current Date

RDS Account Number: [account number]

[Taxpayer Name]

[Taxpayer Address 1]

[Taxpayer Address 2]

[City, State Zip Code]

Your [year] Beer and or Liquor Licenses are due on or before January 11th in order to avoid penalties and

interest. Your remittance should be submitted along with a signed copy of this form for the purpose of

obtaining your annual (jur type) Beer and or Liquor License as well as your retail sales occupational license.

Your [year-1] license expired at MIDNIGHT ON [cdue_date -1]. If you wish to operate after midnight, you

must have your [year] license.

BEER SALES ONLY: Authorizes the retailer to sell for consumption off the licensed premises – Thirty-Five

Dollars ($35.00)

BEER AND LIQUOR CLASS A/B: Authorizes the retailer to sell for consumption on or off the licensed

premises – Five Hundred Dollars ($500.00).

BEER SALES ONLY:

$ _______________

BEER AND LIQUOR CLASS A/B FEE:

$ _______________

INTEREST:

$________________

PENALTY:

$________________

TOTAL REMITTANCE:

$________________

Signature of Applicant: _______________________________________________________________

Title: _______________________________________________________ Date: _________________

Print Name of Applicant: _____________________________________________________________

Telephone: __________________________ Email: ________________________________________

Returned Check Disclaimer: Effective July 1, 2010, each returned item received by RDS due to insufficient funds will be electronically represented to the presenters’ bank no more than

two times in an effort to obtain payment. RDS is not responsible for any additional bank fees that will accrue due to the resubmission of the returned item. Please see the full returned

check policy at