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APPLICATION FOR LIQUOR LICENSE

To the Hon. Board of County Commissioners of Williams County, North Dakota:

The undersigned applicant hereby makes application for license to engage in the retail sale of alcohol and alcoholic beverages for consumption off of (and

on) the premises hereinafter described, for the period beginning January 1, 20__ and ending December 31, 20__, and as a basis therefor makes the following

representations:

Name of applicant _________________________________________________. Age ____________

Address ___________________________________________________________________________

Are you a citizen of the United States? ________________. If naturalized, give date and place of naturalization

________________________________________________. For how long past have you been a resident of the State of North Dakota?__________________

If incorporated give date of charter_____________________________. Is it a North Dakota corporation of authorized capitalization?___________. Amount

of paid in capital $____________________. Is it a subsidiary or any other corporation? ______________. If so, give name and address

_____________________________________________________ Purpose for which incorporated _______________________________________________

Give names and address of all officers, directors and individuals holding 1% of capital stock with amount held by each

______________________________________________________________________________________________________________________________

Description of premises for which license is desired: _____________floor of building located on lot _____________________________________________

______________________________________________________________________________________________________________________________

Name and address of owner of the business premises ___________________________________________________________________________________

Date of the deed or lease for the premises ____________________________________________________________________________________________

Are there any delinquent taxes against said premises? ___________________________________________________________________________________

Have you ever been engaged in the sale or transportation of liquor prior to this application? _______ If so, give date and type of business and address

______________________________________________________________________________________________________________________________

If application is for a renewal, give date applicant first began to operate ____________________________________________________________________

10. Have you ever had a license rejected by any municipality, state or federal authority? __________ If so, give details _________________________________

______________________________________________________________________________________________________________________________

11. Have you ever been convicted of any violation of any law of the United States, or the State of North Dakota, or local ordinance governing the manufacture,

sale or possession of intoxicating liquor? ____________. If so, give date and details __________________________________________________________

______________________________________________________________________________________________________________________________

12. Have you ever had a license for the sale of intoxicating liquor revoked for any violation of any state law or local ordinance? __________ If so, give date and

details ________________________________________________________________________________________________________________________

13. Have you ever been indicted or convicted of any crime other that that stated in (11) either in North Dakota or elsewhere? ___________ If so, give date and

details ________________________________________________________________________________________________________________________

14. Give names and address of all partners, silent or otherwise, interested in any manner in said business, or who will have charge, management, or control of the

establishment for which license is requested __________________________________________________________________________________________

______________________________________________________________________________________________________________________________

15. Has any person, other than applicant, any right, title, estate, or interest in the leasehold, or in the furniture, fixtures or equipment in the premises for which

license is requested? _________ If so, give names, addresses and details _________________________________________________________________

____________________________________________________________________________________________________________________________

16. Have you any agreement or understanding or intention to have any agreement or understanding with any person, partnership or corporation to obtain for any

other, or transfer to any other person this license, or to obtain it for any other than the specific use of the applicant? ______________. If so, give names,

addresses and details __________________________________________________________________________________________________________

17. Have you any interest whatsoever, directly or indirectly, in any other liquor establishment within or without the State of North Dakota? _________ If so, give

names and addresses of establishments ____________________________________________________________________________________________

18. List the occupations which you have followed during the past ten years___________________________________________________________________

____________________________________________________________________________________________________________________________

19. Give names and addresses of at least three business references, including one bank, and state briefly extent of business relations with each

____________________________________________________________________________________________________________________________

20. Are you rated by any commercial agency? ___________ If so, give names and details of rating _______________________________________________

21. Do you intend to handle certain exclusive brands of intoxicating liquors? __________ If so, give details of contract or arrangement with person from whom

purchases are to be made ________________________________________________________________________________________________________

22. Will you be engaged in any other form of business than the sale of liquor under the license applied for? _____ If so, give type of business and name of

employer and address ___________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

23. Give number of Federal Stamp Tax Receipt __________________________________________________________________________________________

24. Do you owe any past due personal property taxes? ___________________

25. Do you promise and agree to abide by the provisions of the initiated law, known as the “Liquor Control Act,” enacted at the election November 3, 1936, and

the rules and regulations passed by the Board of County Commissioners and any future amendments to said law or rules and regulations? ______

26. Are you prepared to furnish a bond in the amount of $___________ as provided for in such rules and regulations? _____ Give name of Surety __________

_____________________________________________________________________________________________________________________________