blank police reports

Document Sample
blank police reports Powered By Docstoc
					INSTRUCTIONS – DO NOT LEAVE ANY QUESTIONS BLANK. APPLICATIONS MUST BE NOTARIZED AND RETURNED TO THE CITY’S LEGAL DEPARTMENT ALONG WITH A $25.00 NON-REFUNDABLE DEPOSIT FEE. CITY OF OAK RIDGE APPLICATION FOR BEER PERMIT Class E Permit (Special Event) Application Number Receipt Number

Name of Organization: Type of Organization (check one): Bonafide charitable organization recognized under Section 501(c) of the Internal Revenue Code Bonafide non-profit organization recognized under Section 501(c) of the Internal Revenue Code Bonafide political organization recognized under Section 2-10-101(a) (political campaign committee) or 2-13-101 (political party) of the Tennessee Code Annotated

Office Use Only Received: Application fee: Records Check:

I hereby make application to the Oak Ridge Beer Permit Board for a Class E beer permit under the provisions of Title 8, Chapters 6-8, Code of Ordinances, City of Oak Ridge, Tennessee and base my application upon the following information: 1. General Information – Organization: Address of Organization Type of Event Date(s) of Event Time of Event Dates of previous events held within the City of Oak Ridge under a Class E Permit within the past twelve (12) months: Time during which applicant desires to sell/distribute beer (cannot exceed seventy-two (72) hours): Specific location where beer will be sold/distributed: Telephone Number

Will beer be sold/distributed for: Consumption only in the location specified Consumption away from the location specified

2.

General Information – Individual Responsible for Supervising the Sale/Distribution of Beer: Full name Address Social Security No. Home Telephone No. Cell Phone No. Date of Birth Sex Driver’s License Number Business Telephone No. Pager No. Race State

Previous Address(es) for the past ten (10) years (attach additional sheet(s) if necessary):

List any convictions (particulars of each charge, court and date convicted) for violations of the beer or alcoholic beverage laws or any crime (other than a minor traffic violation) within the last ten (10) years?

3.

Has either the organization or the individual responsible for supervising the sale/distribution of beer for the event ever had or been denied a liquor license or beer permit? Yes No If yes, where and under what name?

Has any such permit ever been revoked or suspended? If so, where, when and for what reason?

4.

Name and address of person to receive any communication from the City and/or Beer Board regarding this permit, as well as said person’s relationship to the organization:

5.

Name, address and telephone number of property owner, if other than the organization:

6.

Do you agree to not permit gambling, slot machines, punch boards, tip boards or other gaming devices during the event? Yes No Do you agree to not permit sales of beer or other alcoholic beverages to persons who appear intoxicated? Yes No Do you agree to not permit sales or consumption of beer or other alcoholic beverages to or by minors (persons under the age of twenty-one(21)), or to allow loitering by minors on the premises near where beer is sold/distributed? Yes No Do you agree to observe and comply with the laws, ordinances, rules and regulations governing the sale of beer with have been, or may hereafter be adopted and ratified by the Oak Ridge City Council? Yes No

7.

8.

9.

By my signature below, I do hereby further declare that:     Minors will not be employed directly in the sales or distribution of beer. Clean, sanitary facilities will be provided. The business will be conducted in an orderly, peaceable and lawful manner and no loud or obnoxious noises will be allowed. The applicant, as well as any agents/employees of the organization, have not been convicted of any violation of the statutes of Tennessee prohibiting the possession, sale, manufacture or transportation of intoxicating liquor, drugs or any other crime involving moral turpitude within the past ten (10) years. No beer or other alcoholic beverages will be sold or consumed on the premises except during lawful hours as set by City ordinance and sales/consumption shall not occur after 3:00 a.m.. The person or entity is authorized to do business within the City of Oak Ridge and the State of Tennessee. Should any change occur in this application prior to the expiration of the Class E permit, the City’s Legal Department at 425-3530 will be notified as soon as practicable. The City Manager (through the Oak Ridge Police Department) has full power, including right of entry, to enforce the beer ordinances and to inspect and investigate any reported or alleged violations without the necessity of a search warrant. The beer permit, once obtained, shall at all times be posted in a conspicuous place on the premises that is easily seen by patrons. The beer permit may be revoked or suspended, after notice and a hearing by the Board, for any violations of the above statements, for any misinformation or omission contained within this application, for any violation of the Code of Ordinances, Title 8, Chapters 6-8, or for any violations of State law relating to beer, alcohol or crimes of moral turpitude.

     

I solemnly swear that each and every statement made by me in the above application is true and correct and agree that if any statement therein is false, the Board may upon notice and a hearing take action against the organization by setting a monetary penalty or by suspending the organization’s ability to obtain another permit for a period up to one year, in which event the burden shall be upon the permittee to prove the correctness of all statements in this application. I hereby release, absolve and hold harmless the City of Oak Ridge, the Oak Ridge Beer Permit Board, the Oak Ridge Police Department, its employees, agents and representatives from any and all liability of whatever type for any damages, causes of action, personal property injuries which may result as a consequence of my application for a beer permit, background investigation, release of documents or other matters related to my application. I hereby waive all possible liability of the City of Oak Ridge, the Oak Ridge Beer Permit Board, the Oak Ridge Police Department, its employees, agents and representatives as stated above. Furthermore, I declare that I am the of the organization and in such capacity I am authorized to execute this application on behalf of said organization. This the day of , .

Signature of Applicant Sworn to and subscribed before me this My commission expires: day of . , .

Notary Public

DO NOT WRITE BELOW THIS LINE Advertised Hearing Date Approved: Yes Any conditions: No

Signature of Beer Permit Board Secretary