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					TEXAS ALCOHOLIC BEVERAGE COMMISSION APPLICATION FOR TWO-YEAR RENEWAL OF PRIVATE CLUB EXEMPTION CERTIFICATE PERMIT WITH FOOD AND BEVERAGE CERTIFICATE
TWO-YEAR RENEWAL NOTICE FOR: EXPIRES:
FIRST READ ALL INSTRUCTIONS Check information in numbers 1 through 5 for accuracy. Indicate minor corrections for trade name and mailing address. For changes to the applicant entity or a complete change of location address, see instructions on last page. 1. Mailing Address: 2. Trade Name:

FORM NE-FB

3. Location Address:

4. Mailing Address:

LICENSE/PERMIT NUMBER

ISSUE DATE

TWO-YEAR FEE

TWO-YEAR SURCHARGE

LATE FEE

TOTAL FEES DUE

/

/

BOND INFORMATION

REGISTRY NO.

5. Application is filed by:

This does not represent the entire business entity structure on file with the Texas Alcoholic Beverage Commission. The license/permit holder is responsible for notifying TABC of any organizational changes at any level of your business structure. Failure to do so may result in the cancellation of your license/permit.

QUALIFICATIONS 6. Is this application being made by you for the benefit of someone else? If “YES,” indicate below or attach explanation. 6. YES NO

7. Has the applicant, applicant’s spouse, partner, officer, director or stockholders, of the licensed entity become disqualified by law or by facts and conditions from holding a license or permit under the Texas Alcoholic Beverage Code? If “YES,” indicate below or attach explanation.

7.

YES NO

8. Have there been changes since your original application that have not been reported on this or previous applications? If “YES,” indicate below or attach explanation.

8.

YES NO

LICENSE/PERMIT NUMBER: 9. Does applicant require employees to attend a seller training course? 10. Provide sales data for the last year of operation or the projected yearly sales at the licensed premises: Alcoholic Beverage Sales: Food Sales: $ $ Other Sales: Total Sales: $ $ 11. 12. 9.

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YES NO

11. Do you maintain food service at this location? 12. Are the hours of operation for the sale and service of food and alcoholic beverages the same? 13. Indicate primary business at this location: 01 Restaurant 02 Bar 04 Sporting Arena, Civic Center, Hotel 05 Miscellaneous: 10 Pari-mutuel Wagering

YES NO YES NO

14. Does the club have at least 50 members who reside in the county where the club is located or at least 100 members who reside in same and adjacent counties? If “NO,” explain below or attach explanation.

14.

YES NO If “NO,” explain.

15. Is each officer/director at least 21 years old? 16. Has each officer/director been a resident of Texas for one year immediately preceding the filing of this application? If “NO,” explain below or attach explanation.

15. 16.

YES NO YES NO If “NO,” explain.

APPLICANT CONTACT INFORMATION Business Phone # Alternate Phone # Cell Phone # (optional) E-mail (optional)

WARNING: Section 101.69 of the Texas Alcoholic Beverage Code is as follows: “…a person who makes a false statement or false representation in an application for a permit or license or in a statement, report, or other instrument to be filed with the Commission and required to be sworn commits an offense punishable by imprisonment in the penitentiary for not less than 2 nor more than 10 years.”

ACKNOWLEDGMENT
Before me, the undersigned authority, on this of , 20 day the person whose

IMPORTANT: An officer must sign.
PRINT NAME HERE APPLICANT: PRINT NAME SIGN HERE APPLICANT: SIGN NAME AS SHOWN ABOVE SIGN HERE NOTARY PUBLIC

name is signed to the foregoing application personally appeared and, duly sworn by me, states under oath that he or she has read the said application and that all the facts therein set forth are true and correct.

SEAL

INSTRUCTIONS FOR TWO-YEAR LIQUOR PERMITS:
Retain a copy of this renewal for your records. You MUST renew for the entire two-year period. The total amount of fees plus surcharges to cover the twoyear period MUST be paid at the time of renewal. Fees may NOT be prorated or refunded. Sign and have your application notarized. Make two copies. Mail the completed application, fee and surcharge to: TABC PO Box 13127 Austin TX 78711-3127 STATE FEES AND SURCHARGES are printed on the front page. Please add your fees and surcharges together for the total amount due. PAYMENTS: Fees must be paid with a cashier's check, money order or company firm check payable to the Comptroller of Public Accounts. Personal checks will not be accepted. The postmark date will serve as proof of timely filing. LATE FEES: If you do not file this application before your expiration date, your license/permit will expire. Your expiration date is printed at the top of the front page. You may file your renewal within 30 calendar days after your expiration date along with all fees and surcharges plus a $100 late fee for each license/permit renewed. After the 30th day, you must file an original application. You will not be allowed to sell/serve alcoholic beverages until your application and renewal fees are received or until your original license/permit is issued. OTHER FEES: Please note alcohol license/permit fees may be due to your city/county. It is your responsibility to contact these authorities to determine what amounts, if any, may be due. NOTE: Check information in numbers 1 through 5 for accuracy. Indicate minor corrections to tradename and mailing address directly on this form. Changes in the structure of your business entity or business location address will require additional forms. Contact your local TABC Office or the Licensing Division at 512-206-3360. Minor corrections to the trade name and mailing address can be made on this form by marking through the incorrect information and entering the current information. FOR WINERY (G) AND OUT-OF-STATE WINERY DIRECT SHIPPER PERMIT (DS) HOLDERS ONLY: Include with this renewal a newly executed Liquor Tax Bond to cover the two-year period. Tax security will be accepted in the form of a Bond (Form 2-51.3), Certificate of Deposit/Savings Account (Form 2-37.4) or Letter of Credit (Form 2-26.7). These forms can be found on our website, http://www.tabc.state.tx.us/. FOR MIXED BEVERAGE RESTAURANT PERMIT WITH A FOOD AND BEVERAGE CERTIFICATE (RM) ONLY: Submit renewal and fees for both the RM and Food and Beverage Certificate (FB). You must maintain your Food and Beverage Certificate at all times. You may not submit a Conduct Surety Bond in place of the Food and Beverage Certificate.

For forms and additional information visit us at: www.tabc.state.tx.us


				
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