New Submission

Name*

Home Address*

Street Number & Name, City, State, Zip

Phone*

Email*

Date of Birth*

Date/Place of Naturalization

The following questions are in relation to the McHenry City Liquor Ordinance and Illinois law as it pertains to liquor licensing. All questions must be answered honestly. Failure to do so may disqualify you from the application process.

Laws*

Are you familiar with all the laws of the United States, State of Illinois and ordinances of the City of McHenry pertaining to the sale of alcoholic liquor; and will you abide by them?

YesNo

Accidents*

Will you maintain the entire premises in a safe, clean and sanitary manner free from conditions, which might cause accidents?

YesNo

Fights*

Will you attempt to prevent rowdiness, fights and disorderly conduct of any kind and immediately notify the McHenry Police Department is any such events take place?

YesNo

Alcohol Violations*

Have you been convicted of any violation of any law pertaining to alcoholic liquors

YesNo

Violation Info

Please provide a description of the violation, including date and location

Conviction*

Have you been convicted of a felony or misdemeanor?

YesNo

Conviction Info

Please provide an explanation

Improper Serving

Will you and all your employees refuse to serve or sell alcoholic liquor to an intoxicated person or to a minor?

YesNo

Gambling Offense*

Have you been convicted of a gambling offense

YesNo

Gambling Info

Please provide an explanation

I, the undersigned, being first duly sworn, deposes and says that I (we), have read the above and foregoing Application, caused the answers to be provided thereto and all of the information given on said Application to be true and correct, and consent to investigation and background check by the Local Liquor Control Commissioner or his designee and agree to comply with all City Ordinances and the rules stated on this application.

Acknowledgement*

I understand that checking this box constitutes a legal signature and confirms that I have filled out this form to the best of my ability.

Signature*

Liquor License Change of Manager/Business Agent

Business Agent/Manager