Lawton Alcohol License Application - Off-Premise (Convien. Store)

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					                                      COMMUNITY SERVICES DEPARTMENT
                                         LICENSE & PERMIT CENTER / INSPECTION SERVICES
                                                                        th
                                                  Address: 212 SW 9 Street, Lawton, Oklahoma 73501
                                                      Phone (580) 581-3360 • Fax (580) 581-3479
                                                                www.cityof.lawton.ok.us




                         FOOD AND OFF-PREMISE RETAIL DEALER
                                LICENSE APPLICATION
NEW APPLICATION                             RENEWAL                             DATE:

                                                BUSINESS INFORMATION
Business Name:
Business Street Address:
Business Mailing Address:
City/State/Zip:                                                  Business Telephone No:
Legal Description of Property (Street Address Is NOT Acceptable)
Lot:             Block:          Addition:



                                       OWNER/CORPORATE INFORMATION
Business Owner’s Name*:                                                 Is Business a Corporation? YES          NO
Owner’s Address:                                                        Business Tax ID #:
City/State/Zip:                                                         Telephone No:
*List all names and social security numbers used in the preceding five (5) years of ALL individuals owning at least 10% interest in
the business. Additional sheets attached? Yes         No
Owner’s Names:                                        Social Security Numbers:                    Driver’s License Numbers:




                                      APPLICANT/MANAGER INFORMATION
Applicant/Manager’s Name:                                              Relation To Business:
Home Address:                                                          Cell Phone No:
City/State/Zip:                                                        Home Telephone No:

I certify under penalty of perjury that the information contained on this application is true and correct. I further understand
that any incorrect information contained on this application may result in the revocation of any license issued and/or criminal
prosecution.
SIGNATURE OF APPLICANT: ____________________________________________________________


Subscribed and sworn to before me this _______ day of__________________________, 20___.

My Commission Expires: _______________________                Notary Signature: ______________________________________

My Commission Number: _______________________


                                                                  1
                                      DEPARTMENTAL ACTION

ZONING INSPECTOR:          INSPECTION DATE: __________________________           APPROVAL   DENIAL

SIGNATURE: __________________________________________   REPORT ATTACHED?              YES      NO
Comments:


                             LICENSE AND PERMIT CENTER ACTION
APPROVED:                                               DENIED:
License No:                                             Denial Letter Date:
Receipt No:                                             Certified Mail Number:
Issue Date:                Expiration Date:             Appeal Time Expires:
License Clerk:                                          Supervisor Approval:

REV 01/12




                                                   2
           CHECKLIST FOR OFF-PREMISE & FOOD RETAIL DEALER
                         (CONVENIECE STORE)
     (COPIES OF THE FOLLOWING ARE REQUIRED ALONG WITH APPLICATION)


         State Food License (Comanche County Health Department 580‐585‐6699) 
         *If applicable        1010 SW Sheridan Rd 
                               Lawton, Ok 73501 
          
         County Beer License (Comanche County Courthouse 580‐250‐5093) 
                               315 SW 5th Street, Room 504 
                               Lawton, Ok 73501 
 
         Oklahoma Sales Tax (Oklahoma Tax Commission 800‐522‐8165) 
                              2501 N Lincoln Blvd 
                              Oklahoma City, Ok 73194 
          
         Low‐Point Beer Tax (Oklahoma Tax Commission 800‐522‐8165) 
                              2501 N Lincoln Blvd 
                              Oklahoma City, Ok 73194 
 
         Background Check (*Every owner that owns 10% interest or more in the business is 
         required a background check) 
 
         Annual Fee:                          New                  Renewal 
                Background Check (each)       $20.00               $20.00 
                Off‐Premise                   $10.00               $10.00 
                Food License                  $150.00              $150.00 
                                              $180.00              $180.00 
 
    *All employees handling food are required to have a current food handler’s card.  A copy of 
      each employee’s card should be on hand and readily available for inspection by health 
                                            officials. 
 
             For complete information on this license, you should consult our website 
             www.cityof.lawton.ok.us City Code Chapter 12, Article 12‐1 and Chapter 4 

				
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