Form At-315 - Application For Temporary Class "B"/"Class B" Retailer'S License
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1
2APPLICATION FOR TEMPORARY CLASS “B”/"CLASS B" RETAILER’S LICENSE
See Additional Information on reverse side. Contact the municipal clerk if you have questions.
Application Date:
FEE $
Town
Village
City
of
County of
The named organization applies for:
(check appropriate box(es).)
A Temporary Class "B" license to sell fermented malt beverages at picnics or similar gatherings under s. 125.26(6), Wis. Stats.
A Temporary "Class B" license to sell wine at picnics or similar gatherings under s. 125.51(10), Wis. Stats.
at the premises described below during a special event beginning
and ending
and agrees
to comply with all laws, resolutions, ordinances and regulations (state, federal or local) affecting the sale of fermented malt beverages
and/or wine if the license is granted.
1. ORGANIZATION
Bona fide Club
Church
Lodge/Society
Veteran's Organization
Fair Association
(check appropriate box)
(a) Name
(b) Address
(Street)
Town
Village
City
(c) Date organized
(d) If corporation, give date of incorporation
(e) If the named organization is not required to hold a Wisconsin seller's permit pursuant to s. 77.54 (7m), Wis. Stats., check this
box:
(f) Names and addresses of all officers:
President
Vice President
Secretary
Treasurer
(g) Name and address of manager or person in charge of affair:
2. LOCATION OF PREMISES WHERE BEER AND/OR WINE WILL BE SOLD:
(a) Street number
(b) Lot
Block
(c) Do premises occupy all or part of building?
(d) If part of building, describe fully all premises covered under this application, which floor or floors, or room or rooms, license is to
cover:
3. NAME OF EVENT
(a) List name of the event
(b) Dates of event
DECLARATION
The Officer(s) of the organization, individually and together, declare under penalties of law that the information provided in this application
is true and correct to the best of their knowledge and belief.
(Name of Organization)
Officer
Officer
(Signature/date)
(Signature/date)
Officer
Officer
(Signature/date)
(Signature/date)
Date Filed with Clerk
Date Reported to Council or Board
Date Granted by Council
License No.
AT-315 (R. 5-11)
Wisconsin Department of Revenue
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