CITY OF CARROLLTON

750 CLAY STREET/ P O BOX 156

CARROLLTON, KENTUCKY 41008

BUSINESS LICENSE APPLICATION

            1.)            NAME            ______________________________________________

                        (   )            INDIVIDUAL

                        (   )            CORPORATION            (DATE ORGANIZED ___/___/___  STATE ____)

                        (   )            PARTNERSHIP            (LIST NAME & ADDRESSES OF EACH PARTNER):

                        _____________________________________________________________________

                        _____________________________________________________________________

                        (   )            OTHER            ___________________________________________________

                        (   )            SOCIAL SECURITY NO.            _______/_______/_______

                        (   )            FEDERAL I.D. NO.                        _______- _______________

            2.)            TRADE NAME            __________________________________________________

                                                (IF DIFFERENT FROM THAT ABOVE IN ITEM # 1)

            3.)            ADDRESSES  (PLEASE COMPLETE ALL ADDRESSES APPLICABLE)

                                                   (INCLUDE ZIP CODE AND TELEPHONE NUMBERS)

                        (   )            PRINCIPAL BUSINESS            ________________________________________

                                                                                                ________________________________________

                                                                                                __________________PHONE NO.___________

                        (   )            RESIDENCE                                ________________________________________

                                (IF SELF EMPLOYED)

                                                                                                 ________________________________________

                                                                                                  __________________PHONE NO.___________

                        (   )            MAILING ADDRESS                    ________________________________________

                                    (IF DIFFERENT )

                                                                                                                        ________________________________________

                                                                                                    __________________PHONE NO. ___________

            4.)            NATURE OF BUSINESS:

                        (DESCRIBE YOUR BUSINESS AND ITS OPERATION)

                        _______________________________________________________________________

                        _______________________________________________________________________

PAGE 2/APPLICATION/BUSINESS LICENSE/CITY OF CARROLLTON

            5.)            DESCRIPTION OF MERCHANDISE (IF VENDOR/PEDDLER/SOLICITOR)

                        _______________________________________________________________________

                        _______________________________________________________________________

            6.)        DATE TO OPEN/BEGIN BUSINESS:______/______/______

            7.)        IF BUSINESS OBTAINED FROM PREVIOUS OWNER/CHANGE IF BUSINESS:

                        (   )            DATE OF ACQUISITION OR CHANGE: _______/_______/_______

                        (   )            NAME OF PREVIOUS OWNER OR BUSINESS: ______________________

                        (   )            FORMER TRADE NAME, IF ANY:  _________________________________

                                            _________________________________________________________________

            8.)            LOCATION OF RENTAL PROPERTY

                                    ADDRESS                             HOUSE/APT/                 NO. OF UNITS

                                                                                    COMMERCIAL

             _____________________________             _______________             _____________                   

            _____________________________             _______________             _____________         

            _____________________________             _______________             _____________         

            _____________________________             _______________             _____________         

            _____________________________             _______________             _____________         

            _____________________________             _______________             _____________         

            _____________________________             _______________             _____________         

            _____________________________             _______________             _____________         

            _____________________________             _______________             _____________         

            _____________________________             _______________             _____________         

            _____________________________             _______________             _____________         

            _____________________________             _______________             _____________         

            _____________________________             _______________             _____________         

            _____________________________             _______________             _____________         

            _____________________________             _______________             _____________         

            _____________________________             _______________             _____________         

            _____________________________             _______________             _____________         

            _____________________________             _______________             _____________         

            _____________________________             _______________             _____________         

            _____________________________             _______________             _____________         

            (ATTACH SEPARATE SHEET FOR ADD'L PROPERTIES)

            ___________________________________                          _______________________

            SIGNATURE OF APPLICANT                                      DATE

PAGE 3/APPLICATION/BUSINESS LICENSE/CITY OF CARROLLTON

                                                                                                     (FOR OFFICE USE)

                ---------------------------------------------------------------------------------------------------------------------

                (   )            ZONE_______________      (   )            HISTORIC DESIGN STANDARD DISTRICT

      (   )            WATERFRONT DISTRICT

                (   )            RESIDENT (BUSINESS LOCATED IN CITY LIMITS)

                (   )       NON-RESIDENT (BUSINESS NOT LOCATED IN CITY LIMITS)

                (   )            BUSINESS LICENSE ISSUED : (DATE _______/_______/_______)

                (   )            BUSINESS LICENSE DENIED

            REASONS DENIED:            _______________________________________________

                                                            _______________________________________________

            ___________________________________________                      _______________________

                         (SIGNATURE & TITLE)                                                                  (DATE)

            APPLICATION FOR BUSINESS LICENSE FOR "SUNDAY SALES

                            OF LIQUOR BY THE DRINK / RESTAURANT BY THE DRINK"

 

1.)            NAME ________________________________________________

        2.)            ADDRESS OF BUSINESS:

            ______________________________________________________

        3.)            MINIMUM SEATING REQUIREMENT OF 100 PEOPLE AT

                        TABLES FOR DINING

        (  )            PLEASE ATTACH COPY OF FIRE MARSHALL'S CERTIFICATE

                        OF CAPACITY AS PER KRS 227.300 SAFETY REQUIREMENTS.

        4.)            ROOM DIMENSIONS-DRAWING

        (  )            PLEASE ATTACH DRAWING OF PROPOSED DINING AREA

                        WITH DIMENSIONS

                        (DIMENSIONS TO BE CONFIRMED BY ZONING OFFICER)

        5.)        70% OF GROSS RECEIPTS TO BE FOOD SALES

        (  )            PLEASE ATTACH COPY OF STATE OR FEDERAL FORM

                        1040/1120S/720/ETC. WITH ANNUAL GROSS SALES RECEIPTS

        (  )            ATTACH STATEMENT OF FOOD SALES AND LIQUOR SALES

        6.)            RECORDS TO BE MADE AVAILABLE TO CITY ALCOHOLIC

                        BEVERAGE CONTROL ADMINISTRATOR AT HIS DISCRETION

                        FOR AN AUDIT.

            ____________________________________            _____________________

                SIGNATURE OF APPLICANT                          DATE APPLIED

                                                                                    (FOR OFFICE USE )

                    =============================================================

        (  )            APPLICANT HAS VALID "LIQUOR BY DRINK" LICENSE

        (  )            BUSINESS LICENSE ISSUED:  (DATE  ___/___/___)

        (  )            BUSINESS LICENSE DENIED FOR: ____________________________

                           ______________________________________________________________

            _______________________________________            _________________________

                                SIGNATURE & TITLE                                            DATE

SUNDAY SALES OF LIQUOR BY DRINK

STATEMENT OF GROSS RECEIPTS

WITH FOOD SALES AND LIQUOR SALES LISTED INDIVIDUALLY

NAME OF BUSINESS: ____________________________________

            ADDRESS:                     ____________________________________

                                                     ____________________________________

            1.            GROSS RECEIPTS                                      $_____________          100%

                            (AS REPORTED ON FEDERAL OR STATE FORM

                                      720/720C/1040/1120S, ETC.)

            2.         FOOD RECEIPTS                                         $______________            _______%

            3.            LIQUOR RECEIPTS                             $______________            ________%

                         PLEASE ATTACH COPY OF STATE OR FEDERAL FORM

                        1040/1120S/720/ETC. WITH ANNUAL GROSS SALES RECEIPTS

NOTE: SUBJECT TO AUDIT BY CARROLLTON A.B.C. OFFICER

                    _________________________________            __________________________

                            SIGNATURE OF APPLICANT                                        DATE

REV:03.02.06