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Operator's License
Application
Current Year
Application - Upcoming Year
First Name
Middle Initial
Last Name
for the fiscal year ending June 30, 202
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Current Street Address
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Current City, State, & Zip
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Previous Address (include Street, City, State & Zip)
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Telephone No.:
Date of Birth:
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By checking this box, I certify that I am over 18 years of age.
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Sex (M for Male; F for Female; I for other gender type)
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Race
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I will be selling alcoholic beverages for:
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Check all that are applicable: I hereby certify that ...
I am renewing my Operator's License from the previous year.
I have attended the Responsible Beverage Server training course as required by Sec 7-2-35 of the Code of Ordinance (email certificate, unless on file).
I am presently enrolled in the Responsible Beverage Server training course (show proof).
1a) Have you had an operator's beverage license in the Village of Edgar before?
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1b) If yes, what year?
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2a) Have you ever been convicted of violating any liquor license law or ordinance including but not limited to those governing the sale, distribution or consumption of intoxicants? (including under-age liquor)
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2b) if so, when & where?
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3a) Have you ever had an operator's beverage license revoked, suspended or refused by any City, Village, Township, or State?
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3b) If yes, what year?
4a) Have you been convicted of operating a motor vehicle while intoxicated within the last 5 years?
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4a) Have you been convicted of operating a motor vehicle while intoxicated within the last 5 years?
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I certify that I am familiar with the laws, ordinances and regulations involving the sale and service of alcoholic beverages and I hereby agree if granted said license, to obey all provisions of said laws, ordinances and regulations.
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Furthermore, I understand that any intentional misrepresentation, falsification, withholding of information or incomplete answers to questions on this application may result in rejection of the license, and
...that it may be grounds for revocation of the license after it is issued.
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- denotes required field
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