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City adopts liquor ordinance
Approved on first reading
liquor W L

 

The Smithville Board of Aldermen approved an ordinance regulating package liquor sales in the city on a 4-1 vote Monday night.

 

Alderman Shawn Jacobs cast the dissenting vote, saying that he felt the document should include language requiring a minimum amount of inventory, and that audit be performed to make sure that stores were maintaining that amount of inventory. Jacobs said he felt that the city should have approval over the auditors used.

 

Aldermen Josh Miller, and Jason Murphy agreed that minimum inventory guidelines be added, while Gayla Hendrix questioned whether such micromanagement of a business in the city limits was necessary. Hendrix moved to establish $150,000 as the minimum inventory requirement in making the motion to adopt the ordinance, however.

 

The ordinance as approved would establish regulations for parties submitting applications for a certificate of compliance from the city. Applications would be placed in the hands of the police chief and the city attorney for background checks, then would submitted their to Mayor and Aldermen within 30 days. After an applicant receives a clean certificate of compliance from the city, it must be sent to the Tennessee Alcoholic Beverage Commission (ABC).

 

Requirements of the ordinance include:

 

Applicants must have resided of the city for two years or in the county for three years previous to applying. All partners must meet the residency requirements.

Applicants may not have been convicted of a felony within ten years of filing.

Stores will not be permitted within 400 feet of a hospital, school, church, or any place of public gathering, measured in a straight line from front door to front door. If there is no structure on the place of public gathering, the distance would be measured from the front door of the liquor store to the nearest property line of the public gathering place.

A minimum square-footage of 1,500 square feet is required, and the building must be a permanent type structure.

There is no limit set on the number of stores that may operate.

No retailer shall operate, directly or indirectly, more than one store.

Stores could only be operated in appropriately zoned locations.

Stores would be required to maintain a minimum $150,000 inventory

Entrances must be located on the ground floor, with only one main entrance. A store located on the corner of two streets, however, may have a door opening on both streets.

No liquor sales would are permitted for on-premises consumption.

No radios, amusement devices, or seating facilities are allowed.

 

The ordinance authorizes inspection fees and civil penalties for violations.

 

Second and final reading is set for the next regular monthly meeting of the board on at 6 p.m. March 2 at city hall. A public hearing will be held before the vote. The board plans to schedule a workshop sometime before that date to discuss any changes to the ordinance.

 

 

 

The entire ordinance reads:

 

 

 

ORDINANCE NO. 461

 

 

 

AN ORDINANCE TO AMEND TITLE 8 OF THE

 

 SMITHVILLE MUNICIPAL CODE

 

 BY ESTABLISHING PACKAGE LIQUOR REGULATIONS

 

 

 

WHEREAS, the sale of retail package liquor was approved by the voters of the City of Smithville at the November 2014 referendum election; and

 

 

 

WHEREAS, currently the ordinances of the City of Smithville do not permit or regulate retail package liquor sales; and

 

 

 

WHEREAS, the Board of Mayor and Aldermen of the City of Smithville desires to be in compliance with state statutes regarding such liquor sales

 

 

 

NOW, THEREFORE, BE IT ORDAINED by the Board of Mayor and Aldermen of the City of Smithville, Tennessee, that:

 

 

 

SECTION 1. Title 8 of the Smithville Municipal Code is amended by deleting Chapter 1 Intoxicating Liquors in it’s entirely, and by replacing it with the following new Chapter 1:

 

 

 

CHAPTER 1

 

 PACKAGE LIQUOR STORES

 

 

 

Section 1:

 

 8-101. Alcoholic beverages subject to regulation.

 

 8-102. Application for certificate.

 

 8-103. Applicant to agree to comply with laws.

 

 8-104. Applicant to appear before board of mayor and aldermen; duty to give information.

 

 8-105. Action on application.

 

 8-106. Residency requirement.

 

 8-107. Applicants for certificate who have criminal record.

 

 8-108. Only one establishment to be operated by retailer.

 

 8-109. Where establishments may be located.

 

 8-110. Retail stores to be on ground floor; entrances.

 

 8-111. Sales for consumption on premises.

 

 8-112. Radios, amusement devices and seating facilities prohibited in retail establishments.

 

 8-113. Inspection fee.

 

 8-114. Interference with public health, safety, and morals prohibited

 

 8-115. Violations.

 

 

 

Section 2:

 

 8-120. Violations.

 

 

 

Section 3:

 

 8-130. Effective Date.

 

 

 

 

 

 SECTION 1:

 

 8-101. Alcoholic beverages subject to regulation. It shall be unlawful to engage in the business of selling, storing, transporting, distributing, or to purchase or possess alcoholic beverages within the corporate limits of this town except as provided by Tennessee Code Annotated, Title 57, Chapter 3.

 

 

 

8-102. Application for certificate1. Before any certificate, as required by Tennessee Code Annotated, § 57-3-208 or a renewal as required by § 57-3-213 shall be signed by the mayor, or by any aldermen2, an application in writing shall be filed with the city recorder on a form to be provided by the town, giving the following information:

 

 

 

(1) Name, age and address of the applicant.

 

 (2) Time of residence in the town.

 

 (3) Occupation or business and length of time engaged in such occupation or business.

 

 (4) Whether or not the applicant has been convicted of a violation of any state or federal law or of the violation of this code or any town ordinance, and the details of any such conviction.

 

 (5) If employed, the name and address of employer.

 

 (6) If in business, the kind of business and location thereof.

 

 (7) The location of the proposed store for the sale of alcoholic beverages.

 

 (8) The name and address of the owner of the store.

 

 (9) If the applicant is a partnership, the name, age and address of each partner, and his occupation, business or employer. If the applicant is a corporation, the name, age and address of the stockholders and their degrees of ownership of stock in the corporation.

 

 (10) Certain financial information pertinent to the applicant, partnership, corporation and partners or stockholders.

 

 

 

The information in the application shall be verified by the oath of the applicant. If the applicant is a partnership or a corporation, the application shall be verified by the oath of each partner, or by the president of the corporation.

 

 

 

8-103. Applicant to agree to comply with laws. The applicant for a certificate of compliance shall agree in writing to comply with the state and federal laws and ordinances of the town and rules and regulations of the Alcoholic Beverage Commission of the State for sale of alcoholic beverages.

 

 

 

8-104. Applicant to appear before board of mayor and aldermen; duty to give information. An applicant for a certificate of compliance may be required to appear in person before the board of mayor and aldermen for such reasonable examination as may be desired by the board.

 

 

 

8-105. Action on application. Every application for a certificate of compliance shall be referred to the chief of police for investigation and to the city attorney for review, each of whom shall submit his findings to the board of mayor and aldermen within thirty (30) days of the date each application was filed.

 

 

 

The board of mayor and aldermen may issue a certificate of compliance to any applicant, which shall be signed by the mayor or by a majority of the board of mayor and aldermen.

 

 

 

8-106. Residency requirement3. The applicant (majority owner) for a certificate of compliance shall have been a bona fide resident of the City of Smithville for the previous two (2) years or a citizen of DeKalb County for the previous three (3) years. If the applicant is a partnership or a corporation each of the partners or stockholders must meet these residency requirements.

 

 State law reference TCA 57-3-208(c)

 

 

 

8-107. Applicants for certificate who have criminal record. No certificate of compliance for the manufacture or sale at wholesale or retail of alcoholic beverages, or for the manufacture or vinting of wine, shall be issued to any person, (or if the applicant is a partnership, any partner, or if the applicant is a corporation, any stockholder), who, within ten (10) years preceding the application for such certificate of compliance, has been convicted of any felony or of any offense under the laws of the state or of the United States prohibiting the sale, possession, transportation, storage or otherwise handling of intoxicating liquors, or who has during such period been engaged in business, alone or with others, in violation of such laws.

 

 

 

8-108. Only one establishment to be operated by retailer. No retailer shall operate, directly or indirectly, more than one place of business for the sale of alcoholic beverages in the town. The word "indirectly," as used in this section, shall include and mean any kind of interest in another place of business by way of stock, ownership, loan, partner's interest or otherwise.

 

 

 

8-109. Where establishments may be located. It shall be unlawful for any person to operate or maintain any retail establishment for the sale, storage or distribution of alcoholic beverages in the city except at locations zoned for that purpose.

 

 

 

8-110. Retail stores to be on ground floor; entrances. No retail store shall be located anywhere on premises in the town except on the ground floor thereof. Each such store shall have only one main entrance; provided, that when a store is located on the corner of two (2) streets, such store may maintain a door opening on each such street; and provided further, that any salesroom adjoining the lobby of a hotel may maintain an additional door into such lobby as long as the lobby is open to the public. No retail liquor store shall be located in a space of less than 1,500 square feet.

 

 

 

In addition, all liquor stores shall be a permanent type of construction. No liquor stores shall be located in a manufactured or other moveable or prefabricated type building. All liquor stores shall have night lights surrounding the premises and shall be equipped with a functioning burglar alarm system on the inside of the premises. Full, free and unobstructed vision shall be afforded to and from the street and public highway or street to the interior of the liquor store by the way of large windows in the front, and to the extent practicable, to the sides of the building containing the liquor store. All liquor stores shall be subject to applicable zoning, land use, building and life safety regulations, adopted by the town, unless specifically provided otherwise.

 

 

 

8-111. Sales for consumption on premises. No alcoholic beverages shall be sold for consumption, or shall be consumed, on the premises of the retail seller.

 

 

 

8-112. Radios, amusement devices and seating facilities prohibited in retail establishments. No radios, television sets, pinball machines, slot machines or other devices which tend to cause persons to congregate in such place shall be permitted in any retail establishment. No seating facilities shall be provided for persons other than employees.

 

 

 

8-113. Inspection fee. The City of Smithville hereby imposes an inspection fee in the maximum amount allowed by Tennessee Code Annotated, § 57-3-501 on all licensed retailers of alcoholic beverages located within the corporate limits of the town.

 

 

 

8-114. Interference with public health, safety, and morals prohibited. No liquor stores shall be located where such business would cause congestion of traffic or would interfere with schools, churches, or other places of public gathering, or would otherwise interfere with the public health, safety, and morals. In no event will a liquor store be located within four hundred (400) feet of any hospital, school, church or other place of public gathering. The distances are to be measured in a straight line from the front door of the building liquor store to the front door of the hospital, school, church or other place of public gathering. If there is no building on the place of public gathering, the distance shall be measured from the front door of the liquor store to the nearest property line of the place of public gathering.

 

 

 

8-115. Violations. Any violation of this chapter shall constitute a civil offense and shall, upon conviction, be punishable by a penalty under the general penalty provision of this code. Upon conviction of any person under this chapter, it shall be mandatory for the town judge to immediately certify the conviction, whether on appeal or not, to the Tennessee Alcoholic Beverage Commission. However, nothing herein shall be construed to prevent the town from exercising any criminal or civil remedies that it may have with respect to violations of this ordinance.

 

 

 

SECTION 2.

 

 8-120. Violations. Any person who violates any section of this chapter shall upon conviction thereof be punished by a fine of not more than fifty dollars ($50.00) for each offense. Each day a violation continues after a service of notice specifying a compliance date; or each day the action continues after receiving a citation from the Police Department indicating a violation is in existence; or each day after a conviction and the violation continues shall be deemed a separate offense. The court in addition to the fine may include any remedial action that shall be deemed necessary pursuant to the inherent power of the court to resolve the violation.

 

 

 

SECTION 3.

 

 8-130. Effective Date. This ordinance shall take effect after its final passage, the welfare of the City of Smithville demanding it.

 

 

 

1 State law reference

 

 Tennessee Code Annotated, § 57-3-208.

 

 

 

2 State law reference

 

 Tennessee Code Annotated, § 57-3-208 requires the certificate to be signed by the mayor or a majority of the governing body.

 

 

 

3 State law reference 1

 

 Tennessee Code Annotated, § 57-3-208(c).

 

 

 

4 State law reference

 

 Tennessee Code Annotated, § 57-3-208(c).

 

 

 

Passed 1st Reading on

 

 Passed on 2nd and final Reading

 

 

 

Jimmy Poss, Hunter Hendrixson,

 

 Mayor City Administrator

 

 

 

CITY OF SMITHVILLE, TENNESSEE

 

 

 

INSTRUCTIONS FOR APPLICANTS FOR A CERTIFICATE OF COMPLIANCE

 

 TO APPLY TO THE STATE ALCOHOLIC BEVERAGE COMMISSION TO

 

 SELL ALCOHOLIC BEVERAGES AT A RETAIL LIQUOR STORE

 

 

 

1. A Certificate of Compliance shall be issued solely to the applicant, whether a person, firm, corporation, joint-stock company, syndicate, or association.

 

 

 

2. An application for a certificate of compliance must be completed on behalf of all of the owner(s) of the applicant.

 

 

 

3. Separate questionnaires, releases of information for both a record check and financial record check must be completed by all persons having any ownership interest in Applicant.

 

 

 

4. A new release of information request for record check must be submitted when a new person begins managerial duties associated with the business.

 

 

 

5. A certificate of compliance is valid only for the applicant, and cannot be transferred or sold to another person or group.

 

 

 

6. To be considered a complete application, the following must be returned no earlier than __________________ and no later than _________________ at _______ p.m. CST to the city recorder's office. The completed application must include the following:

 

 

 

A. Application for Certificate of Compliance completed and signed by all owners of Applicant with payment of the $ 400 (four hundred dollars) application fee.

 

 

 

B. Individual Questionnaire completed by each person in an applicant group that has any interest in the proposed business.

 

 

 

C. Release for request for record check completed by all parties in an applicant group and the manager of the proposed store.

 

 

 

D. Release for request for financial record check completed by all parties in an applicant group for the proposed store.

 

 

 

E. Affidavit of publication of public notice set forth in the Rules of the Alcoholic Beverage

 

 Commission found in Rule 0100-3.09 (15) and (16) with such notice being published in three (3) consecutive issues of the Smithville Review site plan that is in compliance with the city's prevailing ordinances and regulations.

 

 

 

G. Written documentation from a licensed surveyor that confirms the business location complies with the distance requirements found in Section 8-114 of the Municipal Code.

 

 

 

H. A copy of the official State of Tennessee Liquor Retail License Application.

 

 

 

7. The Board of Mayor and Aldermen will hold a public hearing on the applications and will consider the applications at that meeting.

 

 CITY OF SMITHVILLE

 

 104 East Main Street

 

 Smithville, TN 37166

 

 (615) 597-4745

 

 

 

APPLICATION FOR CERTIFICATE OF COMPLIANCE

 

 

 

$ 400 NON-REFUNDABLE APPLICATION

 

 

 

Date ______________________ FEE PAID ON: _______________________

 

 

 

This application must be complete when submitted to the city recorder. Failure to supply requested information may result in rejection of the application by Board of Mayor and Aldermen.

 

 

 

The name of the Applicant(s) is/are:

 

 _________________________________

 

 

 

The Applicant is a ____ sole proprietorship ____ corporation ____ general partnership

 

 ____ limited partnership or ____ limited liability company

 

 

 

If other than sole proprietorship, list all names, titles and % of ownership of owners of this applicant: ____________________________________________________

 

 ___________________________________________________

 

 

 

List the business address, property tax identification number and current zoning classification of the location for which license is sought: _____________________________________________________

 

 

 

Property owner of proposed location: _________________________________

 

 Owner’s address: ________________________________________

 

 Property owner telephone number: ________________________________

 

 

 

Is property owned by applicant? ____ Is property leased? ___ Term of lease? _________

 

 

 

Does applicant have an option to purchase the property? ____________

 

 

 

If none of the above, explain: _____________________________

 

 

 

Include a listing of persons having any interest, direct or indirect, in such premises.

 

 If license is granted, what is the proposed opening date for this store? ________________

 

 

 

Give name and address of any other business(es) in which owner(s) of applicant are actively engaged: _______________________________________________________

 

 _________________________________________________________

 

 Each Question Must Be Fully Answered

 

 1. Under what name will this business operate? ___________________

 

 ________________________________________________________________

 

 

 

2. What is the applicant’s mailing address? ________________________________

 

 ________________________________________________________________

 

 

 

3. Specify the identity, title, address, and telephone number of the person who is to receive notices and correspondence for the applicant. _____________________

 

 __________________________________________

 

 

 

4. If a corporation, limited partnership, or limited liability corporation, when and where organized?

 

 State: TENNESSEE

 

 Date: ______________________________________

 

 Control Number: ___________________________

 

 

 

5. Has any person having any kind of interest in the applicant been convicted of any offense under the laws of the State of Tennessee, or of any other state, or of the United States; prohibiting or regulating the sale, possession, transportation, storing, manufacturing or otherwise handling intoxicating liquors within ten (10) years preceding the date of this application? ______________

 

 

 

If the answer is yes, list the NAME, DATE, PLACE, OFFENSE and DISPOSITION of all such convictions: ________________________________________

 

 _________________________________________

 

 

 

6. Has any person having any kind of interest in the applicant been convicted within the last ten (10) years for any offense other than minor traffic violations and those specified in 6, above, under the laws of the State of Tennessee or of any other state, or of the United States?

 

 _______________________________

 

 

 

If the answer is yes, list the NAME, DATE, PLACE, OFFENSE and DISPOSITION of all such convictions:

 

 

 

_______________________________

 

 

 

7. Has any person having any kind of interest in Applicant ever been cited to appear before the Commissioner of Revenue, the Tennessee Alcoholic Beverage Commission or the Town of Woodbury and charged with a violation involving alcoholic beverages? ___________

 

 

 

If the answer is yes, list the NAME, DATE, PLACE, OFFENSE and DISPOSITION of all such convictions:

 

 

 

_______________________________________

 

 

 

8. Give the name(s) of the applicant who owns, operates or has any interest, directly or indirectly, in a retail liquor store, wholesale distributor, distillery or supplier?

 

 ___________________________________

 

 

 

9. Give the names and addresses of persons related to any owner of the applicant by blood, marriage, or otherwise who own, operate, or have any interest in a wholesale distributor, distillery or supplier. ______________

 

 _____________________________________________

 

 

 

10. Give the names and addresses of all persons other than those shown on the application who have any kind of interest – financial, loans, gifts, guaranties securing loans, or otherwise – in applicant and describe such interest:

 

 ___________________________________________

 

 

 

___________________________________________

 

 

 

11. Give the names and addresses of all persons other than those shown on the application who will share in the profits or losses of the applicant and state their respective interest: ___________________

 

 _____________________________________________

 

 

 

12. List the full name(s) of the person(s) to serve as on premises manager(s) of the business of the applicant at the location to which this application applies?

 

 ____________________________________________

 

 ____________________________________________

 

 

 

NOTE: The City of Smithville must be notified by certified mail immediately of any changes in on-premises management, and completed individual questionnaires must be submitted with such notification.

 

 

 

13. Are there any outstanding debts at the date this application was filed, (utilities, property taxes, business taxes, fines, fees, etc.) owed by applicant or any owner of applicant to the City of Smithville? (Yes ______) (No ______) If yes, list details, including type, date incurred and amount.

 

 ____________________________________________

 

 ____________________________________________

 

 

 

NOTE: THE APPLICANT(S) WILL HAVE FULL RESPONSIBILITY FOR THE ACTIONS OF ANY AND ALL OF THE APPLICANT’S EMPLOYEES.

 

 

 

14. Attach six (6) copies of a detailed site plan for the proposed business location of Applicant with information referenced in the City of Smithville prevailing ordinances and regulations including, but not limited to Title 8, Chapter 1 of the City of Smithville Municipal Code.

 

 

 

Applicant must submit written documentation from a licensed surveyor that confirms the business location complies with the distance requirements found in Section 8-114 of the City of Smithville Municipal Code with this application. The proposed location must exceed four hundred (400 ) feet as to any hospital, school, church or other place of public gathering. The distances are to be measured in a straight line from the front door of the building liquor store to the front door of the hospital, school, church or other place of public gathering. If there is no building on the place of public gathering, the distance shall be measured from the front door of the liquor store to the nearest property line of the place of public gathering.

 

 15. Attach six (6) copies of a detailed financial plan for applicant that includes projected profit (loss), revenue, and expenditures for a period covering at least five (5) years. Include the initial investment in the building, fixtures and the initial inventory investment. The items listed are the minimum requirements and additional information that would be helpful in the evaluation process should be included.

 

 

 

16. Attach six (6) copies of the following items for each owner of Applicant.

 

 Three trade references

 

 One bank reference

 

 Current Balance Sheet

 

 Current Income Statement

 

 Previous 2 year’s tax returns (personal and business)

 

 Personal financial statement

 

 Applicant or applicants hereby state(s) that he or she meets all of the requirements for obtaining a State Liquor Retailer’s License.

 

 

 

Each applicant or applicants hereby expressly agree to comply with the provisions of the Title 8, Chapter 1 of the City of Smithville Municipal Code and with all applicable state laws, rules and regulations.

 

 

 

WARNING:THIS APPLICATION IS TO BE NOTARIZED AND IS MADE UNDER OATH OR AFFIRMATION. FALSE STATEMENTS MAY BE GROUNDS FOR REJECTION OF THE APPLICATION OR SUSPENSION OR REVOCATION OF THE LICENSE.

 

 

 

(Additional applicant sheets should be attached if necessary).

 

 

 

 

 

 ________________________________ _________________

 

 Signature of Applicant Home Street Address

 

 ________________________________ ____________________

 

 City and Zip Code Home Phone No.

 

 __________________________________ ____________________

 

 Signature of Applicant Home Street Address

 

 __________________________________ _______________________

 

 City and Zip Code Home Phone No.

 

 _________________________________

 

 

 

Signature of Applicant Home Street Address

 

 _________________________________ ___________________

 

 City and Zip Code Home Phone No.

 

 _________________________________ _____________________

 

 Signature of Applicant Home Street Address

 

 _________________________________ ________________________

 

 City and Zip Code Home Phone No.

 

 

 

STATE OF TENNESSEE

 

 COUNTY OF ________________

 

 Before me, a Notary Public in and for the said state and county, personally appeared the above named applicant, with whom I am personally acquainted or proved identity on the basis of satisfactory evidence, the bargainor(s), and who acknowledged the execution of the foregoing instrument (Real Estate Lease) for the purposes therein contained.

 

 Witness my hand and seal at ________________________________________, Tennessee on this __________ day of ____________________, 2015.

 

 ________________________________________

 

 NOTARY PUBLIC

 

 My Commission Expires:

 

 _______________________

 

 

 

CITY OF SMITHVILLE, TENNESSEE

 

 

 

INDIVIDUAL QUESTIONNAIRE RELATIVE TO

 

 APPLICATION FOR CERTIFICATE OF COMPLIANCE

 

 TO SELL ALCOHOLIC BEVERAGES

 

 AT A RETAIL LIQUOR STORE IN SMITHVILLE, TENNESSEE

 

 

 

To be filed by all persons who have any ownership interest in Applicant for which an application for a Certificate of Compliance is on file with the City of Smithville. Each individual owner must submit a separate Questionnaire, which is to be attached to the application.

 

 

 

Date: ____________________

 

 

 

Applicant for License (as listed on application): __________________

 

 

 

Information Relating to Person Completing this Questionnaire (“owner”):

 

Name: ___________________________________________

 

 Business Phone: _____________________ Home Phone: ____________

1. State the amount of capital you propose to invest in the Applicant. $___________

2. What is the source of this capital? (state in detail) ____________

 ______________________________________________

3. If savings or personal funds, give the name of the bank where deposited.

 _____________________________________________

4. If a loan was made for this investment, state the name of the lender and the amount.

 ________________________________________________

 _________________________________________________

5. State names, addresses and type of business of all employment for the past ten (10) years.

 Period of

 

 Employer Address Type of Business Employment

 ____________________________________________________

 ___________________________________________________

 ______________________________________________________

6. State all addresses where you have resided the last ten (10) years. (Address City State)

 __________________________________________________

 ____________________________________________________

 _____________________________________________________

7. Give the name and address of any relatives that have any interest in any liquor business. _______________________________________________

8. Have you been convicted within the last ten (10) years of any violation of any law against possession, sale, manufacture, or transportation of intoxicating liquor, or any crime involving moral turpitude? _____________

If the answer is yes, furnish complete details of all convictions including DATE, PLACE, CHARGE, and DISPOSITION. __________________________________________

 _____________________________________________

9. Have you been convicted within the last ten (10) years of any criminal offense other than minor traffic violations and other than an offense referenced in 9, above? ______

If the answer is yes, furnish complete details of all convictions including DATE, PLACE, CHARGE, and DISPOSITION. _________________________________________________

 _______________________________________________

10. Are you a citizen of the United States? ______ Yes ______ No

If naturalized, set forth DATE, PLACE, and COURT. _______________

 __________________________________________________________

11. Give the names and addresses of five (5) references. At least three (3) must reside or own a business within the corporate limits of the City of Smithville.

 Name Address

 1. ____________________________________________________

 

 2. ___________________________________________________

 3. _____________________________________________________

 4. ______________________________________________________

 5. ______________________________________________________

 12. Do you hold a public office, whether appointed or elected? ______________

13. Are you a public employee, either national, state, county, or city? _____________

14. Furnish your full name, including any nickname or any other names by which you are or have been known. _________________________________________

 __________________________________________

15. Date of Birth: ______________ Place of Birth: _________________

 

Social Security No.: _______________ Driver’s License No.: _______________

________________________________ _______________________

 Signature of Applicant Home Street Address

 ________________________________ ________________________

 City and Zip Code Home Phone No.

 __________________________________ ________________________

 Signature of Applicant Home Street Address

 __________________________________ ______________________

 City and Zip Code Home Phone No.

 _________________________________ ______________________

 Signature of Applicant Home Street Address

 _________________________________ ________________________

 City and Zip Code Home Phone No.

 _________________________________ ________________________

 Signature of Applicant Home Street Address

 _________________________________ ________________________

 City and Zip Code Home Phone No.

 COUNTY OF ________________

 Before me, a Notary Public in and for the said state and county, personally appeared the above named applicant, with whom I am personally acquainted or proved identity on the basis of satisfactory evidence, the bargainor(s), and who acknowledged the execution of the foregoing instrument (Real Estate Lease) for the purposes therein contained.

 Witness my hand and seal at ________________________________________, Tennessee on this __________ day of ____________________, 2015.

 NOTARY PUBLIC

 My Commission Expires:

 _______________________

 CITY OF SMITHVILLE

 104 East Main Street

 Smithville, TN 37166

 

 (615) 597-4745

CERTIFICATE OF COMPLIANCE

 RETAIL LIQUOR STORE

 __________________________________________________________

Pursuant to Tennessee Code Annotated, Title 57, §§ 57-3-208 and 57-3-213, this is to certify that:

Name of Applicant: __________________________________________

Home Address: ______________________________________________

 ____________________________________________________________

 (City) (State) (Zip)

Date of Birth: _________________________ SSN: ____________________

 has made application for a Certificate of Compliance to sell retail alcoholic beverages in the City of Smithville, State of Tennessee, at ______________________________________

 _______________________________________________

 (Street Address of Liquor Store)

and that an investigation has been undertaken of the applicant’s criminal record and of the compliance of said business with local law, ordinances or resolutions, and from said investigation the undersigned certified:

 1. That the applicant or applicants who are to be in actual charge of said business have not been convicted of a felony within a ten-year period, immediately preceding the date of the application and, if a corporation, that the executive officers or those in control have not been convicted of a felony within a ten-year period immediately preceding the date of the application, and further, that it is the undersigned’s opinion that the applicant will not violate any provisions of Tennessee Code Annotated, Title 57, Chapter 3;

3. That the applicant has been a bona fide resident of the City of Smithville and/or Dekalb County for at least (2) years;

4. That the issuance of this license will not exceed the numerical limit.

This the ______ day of _____________________, 20___.

______________________________________

 Mayor Jimmy Poss, City of Smithville

 

MAIL TO: Tennessee Alcoholic Beverage ComDelete - Merge Upmission

 226 Capitol Boulevard Building, Suite #300

 Nashville, Tennessee 37243-0755