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Home My WebLink AboutRes 1993-22 Alcohol Beverage License1 RESOLUTION NO. 22-93 A RESOLUTION OF THE VILLAGE OF NORTH PALM BEACH, FLORIDA, AUTHORIZING AND DIRECTING THE VILLAGE MANAGER TO EXECUTE AN APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE WITH THE DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO, DEPARTMENT OF BUSINESS REGULATION, STATE OF FLORIDA, FOR USE AT THE NORTH PALM BEACH COUNTRY CLUB, WHICH APPLICATION IS ATTACHED AS EXHIBIT "A"; PROVIDING INDEMNIFICATION TO THE VILLAGE MANAGER FOR THE EXECUTION AND SUBMISSION OF THE APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE; AND, PROVIDING FOR AN EFFECTIVE DATE. BE IT RESOLVED BY THE VILLAGE COUNCIL OF NORTH PALM BEACH, FLORIDA: Section 1. The Village Council of the Village of North Palm Beach, Florida, does hereby authorize and direct the Village Manager to execute and submit an application for alcoholic beverage license with the Division of Alcoholic Beverages and Tobacco, Department of Business Regulation, State of Florida., for use at the North Palm Beach Country Club, which application is attached as Exhibit "A". Section 2. The Village Council of the Village of North Palm Beach, Florida, does hereby indemnify and save and hold the Village Manager harmless from loss or damage incurred by reason of the execution and submission of the application for alcoholic beverage license. Section 3. This Resolution shall take effect immediately upon its adoption. PASSED AND ADOPTED THIS *-` :(F LICifa0 As lEd) .rrt, 22nd DAY OF ATTEST : VILLAGE CLERK 1 April , 1993. MAYOR EXHIBIT "A" DBR 42-008 Rev. 2/91 Y/ STATE OF FLORIDA Department of Business Regulation Division of Alcoholic Beverages and Tobacco PERSONAL QUESTIONNAIRE FULL NAME (Include Maiden Name) Do Not Use Initials Dennis Wayne PLACE OF BIRTH: Enid, OK Kelly COLOR HAIR Brown CURRENT RESIDENCE ADDRESS: 412 Northlake Ct., #5 North Palm Beach, FL 33408 COLOR EYES Brown DATE OF.BIRTH: 01/8/47 RACE: SEX: Cau Male HEIGHT: 6'0" HOME PHONE NUMBER: 40?/845-'917.1 BUSINESS PHONE: 4U7/848-3476 AGE: 46 WEIGHT: 185 Are you a citizen of the United States? yes If the answer is no, complete the following: Are you legally in this country? Alien Registration Number LIST EMPLOYMENT FOR THE PAST FIVE YEARS - INCLUDE ANY PERIOD OF UNEMPLOYMENT Period From To Job Title 1989 presenll Village Manager Employer's Name and Address with Zip Code NortngFalm Beach • Have you ever been in this state, any other state, by the United States, or by any foreign country: YES NO 1. Arrested or charged with any violation of the law excluding minor traffic violations? X If yes, were you convicted? 2. Have you in the past or presently, individually or as an officer of a corporation: a. Held, or had an interest in a beverage license or cigarette permit? X b. Been denied a beverage license or cigarette permit? X c. Had a beverage license or cigarette permit revoked? X d. Held stock or had any interest in, affiliated or. connected with, directly or indirectly, any business which manufactures, distributes, imports, exports or sells at retail any alcoholic beverages? X 3. Are you an official with state police powers granted by the Florida Legislature or designated as a law enforcement officer by 33-4.001, Florida Administrative Code? X If the answer to any of these questions is YES, list full particulars which include' charges, date and place of arrests, arresting agencies, whether convicted and give business names, cities, states and dates. (Attach extra sheets if necessary.) F F I D A V I T In compliance with Florida Beverage Laws and Regulations, I hereby certify that Dennis Wayne Kelly (Name of Person to be licensed) of Village of North Palm Beach, 501 U.S. #1, N. Palm Beaeh. FL 33908 (Complete Address) was fingerprinted by me for the Florida State Division of Beverage and that the attached fingerprints are his/hers. (Signature ~~ Officer) Public Safety Department (Department) Village of North Palm Beach, FL (Address) Sworn to and subscribed before me this day of 19 (Notary Public) My Commission Expires: PLEASE PRINT NAP1E K 1 LAST FIRST MI DLE ADDRESS 412 Northlake Ct. #5, North Palm ReAeh, Ft, 33408 CITY STATE ZIP U.S. CITIZEN YES X NO - OTHER COUNTRY SEX M RACE W HGT 6'0" WGT 185 EYES Br HAIR Br DATE OF BIRTH 01/08/47 CITY Enid STATE - OK SOCIAL SECURITY NUMBER 267-?0-6143 NAME AND ADDRESS OF BUSINESS TO BE LICENSED Village of North Palm RPanh aka North Palm Beach Country Club Restaurant. 501 U.S. Hie~hwav #1. North_Palm_BQach__Fi. 43408 PHONE NUMBER WHERE YOU CAN BE CONTACTED (407) '848-3476 00fl44-ooa6 R,v.0190 • STATE OF FLORIDA Dopartmont ol Buslnoss Rogulation Division of Alcoholic Bovoracos and Tobacco ELECTION OF SURCHARGE PAYMENT METHOD AND CERTIFIED INVENTORY REPORT This application Is for a:#{)NEW LICENSE, ( )TRANSFER OF LICENSE or a ( )t-Day, ( )2-Day, ( )3-Day PERMIT; PERMIT EXPIRES • JJ._ APPLICANT'S NAME: N. Palm Bench Country Cluh ❑' Ihombypormanontlyoloclropay (Wm surcharpos Restaurant based on purchases. BUSINESS NAME: Village of North Palm Beach Act, Nona( pormanon(lyoloct(opay lu(uro MAILING ADDRESS: 5 0 1 U.S. Highway # 1 , NPB, suroharpos based on purchpsos, Thorofare, I will FL 33408 paybasod onsalos.. LOCATION ADDRESS: 901 U.S. Highway #1 LICENSEa ' t CITY: North Palm Beach ,FL. COUNTY: Palm Beach • zIP:33408' NAME OFCONTACT PERSON: ShaUkat Khan PHONE# (407) 848.3474 Finance Director • II person preparing monthly reports is dilierent Irom abovo, ploaso Ilst name and phono number below: • NAME: Alan Sayer Appliclnt•s Sipnaluro FORMER BUSINESS NAME: PHONE # (4167) '626'-4345 •' Couptry Cliih'Mar , 4/19/93 •.Titlo Dato ' I FOR:LICENSETRANSFERS ONLY I NOT APPLICABLE LICENSE NUMBER: - SERIES: This is to corlily that as loimor ownor of lhls (Icons° or authorlzod toprosonlativo ol ihls Iiconsoo. I usod lho _PURCHASES _ SALES mothod to dotonnlno tho amount of bovorogo suroharpos duo and that paymon% ol those SURCHARGES is current as of Signaturo of Former Owner Dato or Authorized Roprosontativo INVENTORY TO BE TRANSFERRED FOR CONSUMPTION ON PREMISES Gallons Draft Boor Gallons Coolorc Gallons Liquor Gallons Packaged Boor Gallons Wino WE CERTIFY THAT THIS INVENTORY IS TRUE AND CORRECT TO THE BEST OF OUR KNOWLEDGE AND BELIEF, Signaturo of Former Owner Signature ol Applicant or Authorizod Roprosontolivo " NOTICE TO ALL COP APPLICANTS" ALCOHOLIC BEVERAGE SURCHARGE TAXESARE DUE BY THE tSTH OF EACH MONTH. irIS THE VENDORSRESPONSIBILITY TO CONTACT THEPLANTATION AUO/TINC OFFICOA rposi 797-8493, TO oornu THEREDU/REO FORMSS /NSTRUCT/ONS. ALCOIIOUO BEVERAGE SURCHARGE TAXES FOR ONE, TWO, OR THREE DAY PERMITS ARE OUE20 DAYS AFTER THE EVENT.. FAILURE TO FILE a PAY SURCHARGE TAXES WILL RESULT IN PENALTIES OF t 90 PER DAY OR SI.00 PER DAY, WHICHEVER IS GREATER, • , ;, AND MAY RESULTIN THE / !EVOCATION Of YOUR LICENSE, 1•,ty ;1„, DEPARTMENT OF BUSINESS REGULATIONS . DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO LICENSE/PERMIT APPLICATION WAIVER • Chapters 120 and 561 of the Florida Statutes require your application.be processed within ( ) 90 days ( ) 180 days. The Division of Alcoholic Beverages and Tobacco is unable. to meet the time requirements in your case. Therefore, the Division requests you waive the time 'requirements for processing your application. Your application will be processed as expeditiously as possible. If you wish to valve the above limitations, please complete the following: Business Name: North Palm Beach Country Club Restaurant Applicant's Name: Village of North Palm Beach Business Address: 501 U.S. Highway #1 Street Number North Palm Eeach City Phone No.: Area code ( 407) 848-3476 Palm Beach, FL 33408 County Zip I do hereby waive all time restrictions surrounding the processing of the above referenced application. I do so knowingly and voluntarily. 04/19/93 Date Signature oY\ Applican DBR 42-001 Rev. 7/91 SECTION I STATE OF FLORIDA Department of Business Regulation Division of Alcoholic Beverages and Tobacco APPLICATION FOR•ALCOHOLIC BEVERAGE LICENSE AND CIGARETTE PERMIT BUSINESS TELEPHONE 4 407/848-3476 TYPE OF LICENSE/PERMIT DESIRED: Check Appropriate Boxes (X) Alcoholic Beverage License TYPE OF APPLICATION: Check Appropriate Boxes (X) New ( ) New - Temporary ( ) Transfer ( ) Transfer - Temporary ( ) Change of Location TYPE OF APPLICANT: Check Change of Location Temporary Change in Series Decrease in Series Increase in Series Appropriate Box and List ( ) Cigarette Permit ( ) Change of Business Name ( ) Change of Officers/Stockholders ( ) Correction ( ) Other Charter Number, If Applicable ( ) Individual ( ) Partnership (X) Corporation ( ) Limited Partnership ( ) Charter Number (Municipality) 1. Applicant's Full Name: North Pnlm Beach Country Club Restaurant 2. Business Name: Villnoe of North Palm Beach 3. Location Address: 901 U.S. #1. Street 4. Mailing Address: 501 U.S. #1. Street If North Palm Beach, City North Palm Beach, City FL State FL State 33408 Zip 33408 application is for a NEW license/permit, questions 5-8 are not applicable. 5. Current owner's Name: N/A 6. Current Business Name: N/A Zip 7. Current Location Address: N/A Street City State Zip $ Current License/Permit Number: N/A Current Series: 9. Series of Licenses/Permits Desired: ( 4COPSRX ) AND ( ). 10. Complete the following if you are an applicant for a quota, special or club alcoholic beverage license. The license is issued pursuant to Florida Statutes or Special Acts, and as such we acknowledge the following minimum requirements must be met and maintained: (1) Country Club Administrative Board Members TITLE/POSITION NAME Chairman M. C. Love Vice Chairman Chuck Weston Board Members: Arnold Hess Leonard Pellegren Frank Shone Lucia Traugott Dick Voss SECTION III '1. • SALES TAX: Owners Name: Vi11aRe of North Palm Beach Business Name:North Palm Beach Country Club Restaurant A. Disclosure Authorization. Section A is to be Completed By Owner Only if Transfer of Alcoholic Beverage License. N/A I hereby authorize the Department of Revenue to release to the aforementioned applicant and to the Division of Alcoholic Beverages and Tobacco the current status of my account Sworn to and subscribed before me this day of , 19 /44 Owner or Authorized Corporate Officer Must be Notarized Notary Public My Commission Expires: B. Disclosure. Section B is to be Completed by Department of Revenue. 1. This is to verify that the current owner as named in this application has filed all returns and that all outstanding billings and returns have been paid through the.period ending N/A or the liability has been acknowledged and agreed to be paid by the applicant'. This verification does not constitute a certificate as contained in Section 212.10(1), F.S. (Not applicable if no transfer involved). 2. Furthermore, the named applicant for an Alcoholic Beverage License has complied with Florida Statutes concerning registration for Sales and Use Tax, and has paid any applicable taxes due. 04/19/93 (Signed) (Title) (Date) DEPARTMENT OF REVENUE STAMP (3) D. Is the proposed premises MOVABLE or ABLE TO BE MOVED? (YES) (NO) X E. Is the proposed premises located in a shopping center, mall or office building? X F. Is there any access through the premises to any area over which you do not have dominion and control? X G. Is the premises occupied by anyone not listed on this application?.. X SECTION V FEDERAL EMPLOYER'S IDENTIFICATION NUMBER A. Federal Employer's Identification Number: 59-6017984 B. Not Required ( ) C. Not Available ( ) I will submit to your agency as soon as possible. SECTION VI These questions must be answered about this business for every person or entity listed. Copies of agreements and documentation to support the financial arrangements must be submitted with this application. NOT APPLICABLE YES NO 1. Is there a management contract or service agreement in connection with this business? ( ) ( ) 2. Are there any agreements which require a payment of a percentage of gross or net receipts from the business operation? ( ) ( ) 3. Does anyone hold a mortgage or security agreement for this business? ( ) ( ) 4. Have you or anyone listed on this application borrowed money from or accepted money, equipment, fixtures, or anything of value from an owner or representative of a distiller, rectifier, blender, bottler, manu- facturer, brewer, distributor, exporter, importer or retailer or secured a loan from any source connected with the alcoholic beverage - industry? ( ) ( ) 5. If purchasing the business, what is the purchase price? 6. List the total investment• A. Total CASH invested B. Total LOANS invested N/A N/A N/A N/A (5) SKETCH OF LICENSED PREMISES Sketches should be drawn in ink and include all walls, doors, counters, sales area's, storage areas, restrooms, bar locations and any other specific areas which are part of the premises sought to be licensed. A multi —story building where the entire building is to be licensed must show each floor. Floor Plan Attached (7) EAVE BLANK APPLICANT 412 Northlake Ct., #5 N. Palm Beaeh, FL 33408 Village of N. Palm Bch. 501 U. S. Highway #1 North Pa lm_Bch. . FL 33408 pFATON RNGERPRINTfO Liquor License application c/o Village of N. Palm Bch. .~i~~l ~ /, / L p. (NUMB ~ ] R. INOfY - 6 l 1NUMR - TYPE OR PRINT ALL INFORMATION IN BLACK IATf NAMf NAM FIRTI NAMF MIDDIF NAM[ Kelly "Dennis Wayne ALIATFT ~ ^ O none R I ~~.. ~7~7Cf ctl` rl1l+ c'+L.C F3Ei! ?, 717g 1Al...l_f;Mf<SSEE, F'l. :IEIZENSNIP ~ aACE tl~). WGf L U. S. M W Rlnu Toc c f-r_-o ly~_ lU EOVS HO. m~J n~a 'TS ~? ~.,J R~. II ~'~.5,~~ .. CIATT REf. ~' IEAVE BLANK Men1M1 '~` ,~'' '~' ,r t ~C Tn 5 W. W T~x ~e~qi. \~ . f t .~ .. i ~~ ; B ~. h ' Sn ~ ~_ r ~ L' .f..'~.C'~~{ LIHUMR 6, a EHUM6 < .. >e.: ~'~ - ,::.. i 1 R /'Te~f 1. < pivl t ~', • f ~'$ { :' ~. - y . f,-- . J:1 BI,: