Liquor L Transfer Taste of DbqkALCOHOLIC
BEVERAGES
DIVISION
i state of Iowa
Thomas J. Vilsack Governor of Iowa
Sally J. Pederson Ueutenant Governor
Lynn M. Walding Administrator
Licenses may be transferred from one location to another, but only within the boundaries of the current approving Local
Official. The Transfer Application and all supporting documentation shall be approved by the Local Official and
forwarded to the Iowa Alcoholic Beverages Division before the event takes place. All selling and serving of alcoholic
beverages must cease at the original licensed location during the period of the transfer. NOTE: If requesting a
permanent transfer, an amended license will be forwarded to the Local Official. If requesting a temporary transfer, a
letter of permission will be forwarded to the Local Official.
License Number:
Name of Applicant:
(Sole Proprietorship, partnership, Ctaporation, etc.)
Name °f Business (D/B/A): ~"~ %0~,
Address of Premise:
Address of: Pr°Posed Premi'se:
City:
Zip:
Phone:
~ Tcurgaorary Transfer (24 hours through 7 days):
Beginning Date: ~f] ~ ] O '~ Ending Date:
[] Permanent lransfer (more than 7 days): Beginning Date:
(Dates must fall within license period).
On-Premise Applicants Only:
l~ram Shop Liability Certificate of Insurance Dates: From:
(Certificate dates shall correspond with requested transfer dates.
InsUranc~ Accord Certificates not accepted)
Attach copy of Dram Shop Liability Certificate oJ
www. IowaABD.com
Iowa Alcoholic Beverages Division, 1918 SE Hulsizer Road, Ankeny, Iowa 50021 515.281.7430 866.IowaABD 866.469.2223
All Applicants:
4-I. ~- Number of baflaooms.
Page 2
4-2. i Number of floors ~vhere alcoholic beverages will be sold, served, consumed and s~ed.
4-3. Indicate how you have control of the premises (Permanent Transfers only): ~ Own [] Lease
Submit signed copy of the lease/rental agreement for the license period or signed final sales conlxact or wa~anty deed.
44. Attach a sketch on 8 ½ x 11" white paper of the proposed premises showing all areas and floors where alcoholic beverages
will be sold, served, consumed and stored. Indicate all entrsnces and exits, location of bar, back bar and bathrooms. It
Applicant has Outdoor Sexvice Area Privilege, please include in the sketch its relationship to the licensed premise.
4-5. Outdoor S~rvice Area Dates (ifapplicable): From: <7~][~](~ ~ To:
t
4-6. Attach original Dram Shop Endomemant. Dates shall correspond with requested outdoor service area dates. (Accord
Certificates are not accepted)
On-Premise Applicants Only:
4-7. [] Y [] N Is the premise fmmished with tables and seats to accommodate a mihiraum of 25 persons at one time?
Off-Premise Applicants Only:
4-8. (Class C Beer Applicants only). Square footage of the entixe retail sales area of the business, including area of
walk-in coole~ that are accessible to the public. This includes all areas where non-alcohol Ixoducts are also
sold. Do not include areas that are not accessible to the public (offices, bathroom kitche~ storage areas, etc.).
4-9. (Class E Liquor Applicants only). Squere footage of the entire interior area of the building hichiding, but not
limited to, all areas used in the storage, distributio~ warehousing, display, wholesale and retail sale of
merchandise, offices, bathrooms, break rooms, etc.
The Transfer Application shall be signed by a person listed in the Ownership Section of the original license Applicatiom
Stamped signatures are not acceptable.
I hereb~dec~re thai all informa.~tion~ontained in the Application is true and correct.
Applicant's Signature l~at~ Print Applicant's Name -
This document is subject to Iowa's Open Record law. Information contained in the Application may be disclosed without p~or
notice to orpermission from the Applicant. Se~e Iowa Code cbs. 22 and 123. See also 185 Iowa Administrative Code, ch. 18.
I hereby certify that the Transfer Application was submitted to:
City Council or County Board of Supervisors
It is recommended that the Transfer be:
Outdoor Service Area (if applicable):
on
[] Approved [] Denied*
[] Approved [] Denied*
Name of City or County Signature of City or County Official
*If the Application is denied, attach a separate sheet identifying specific reasons for the denial
Date
( )
Daytime Phone
kkALCOHOLIC
BEVERAGES
DIVISION
State of Iowa
Thomas J. Vilsack Govemor of iowa
Sally J. Pederson Lieutenant Governor
Lynn M. Walding Administrator
Licenses may be transferred from one location to another, but only within the boundaries of the current approving Local
Official. The Transfer Application and all supporting documentation shall be approved by the Local Official and
forwarded to the Iowa Alcoholic Beverages Division before the event takes place. All selling and serving of alcoholic
beverages must cease at the original licensed location during the period of the transfer. NOTE: If requesting a
permanent transfer, [tn ame}tded license will be forwarded to the Local Official. If requesting a temporary transfer, a
letter of permission will be forwarded to the Local OffcialJ
License Number:
Name of Applicant:
(Sole Proprietorship, Par tnership, Colporation, etc.)
Nme of Business (D/B/^):
Address of Premise:
~r~mporary Transfer (24 hours tt~ough 7 days):
Beginning Date: ~ Ending Date:
[] Permanent transfer (more than 7 days): Beginning Date:
zip:
Phone:
(Dates must fall within license period).
On-Premise Applicants Only:
Dram Shop Liability Certificate of Insurance Dates: From:
(Certificate dates shall correspond with requested transfer dates.
Insuranc& Accord Certificates not accepted)
Attach copy of Dram Shop Liability Certificate oJ
www. IowaABD.com
Iowa Alcoholic Beverages Division, 1918 SE Hulsizer Road, Ankeny, Iowa 50021 515.281.7430 866.IowaABD 866.469.2223
All Applicants:
Number of bathrooms.
Number of floors where alcoholic beverages will be sold, served, consumed and stored.
Page 2
4-3. Indicate how you have control of the premises (Permanent Transfers only): ~ Own []
Lease
Submit signed copy of the lease/rental agreement for the license period or signed final sales contract or warranty deed.
4-4. Attach a sketch on 8 ½ x 11" white paper of the proposed premises showing all areas and floors where alcoholic beverages
will be sold, served, consumed and stored. Indicate all entrances and exits, location of bar, back bar and bathrooms. Ii
Applicant has Outdoor Service Area Privilege, please include in the sketch its relationship to the licensed premise.
4-5. Outdoor Service Area Dates (if applicable): From: ~/~.~/~ To: ~/~/~,_~
4-6. Attach original Dram Shop Endorsement. Dates shall correspond with requested outdoor service area dates. (Accord
Certificates are not accepted)
On-Premise Applicants Only:
4-7. ~Y [] N Is the premise furnished with ~abtes and seats to accommodate a minimum of 25 persons at one time?
Off-Premise Applicants Only:
4-8. (Class C Beer Applicants only). Square footage of the entire retail sales area of the business, including area of
walk-in coolers that are accessible to the public. This includes all areas where non-alcohol products are also
sold. Do not include areas that are not accessible to the public (offices, bathroom, kitchen, storage areas, etc.).
4-9 (Class E I~iquor Applicants only): Square footage of the e~ti~e interior area of the building including, but not
limited to, all areas used in the storage, distribution, warehousing, display, wholesale and retail sale of
merchandise, offices, bathrooms, break rooms, etc.
The Transfer Application -shall be signed by a person listed in the Ownership Section of the original license Application.
Stamped signatures are not acceptable.
I hereb)~decl~re that all infortnatio c~ontained in the Application is true and correct.
Applicant's Signature ' . - D~te Print Applicant's Name
~7~is document is subject to Iowa's Open Record law. InJbrmation contained in the Application may be disclosed without prior
notice m orpermission from the Applicant. See Iowa Code cbs. 22 and 123. See also 185 Iowa Administrative Code, ch. 18.
6. E~ORSEMENT OF LOCAL AUTHORITY.
I hereby cexfify that the Transfer Application was submitted to:
on
City Council or County Board of Supervisors
It is recommended that the Transfer be: [] Approved [] Denied*
Outdoor Service Area (if applicable): [] Approved [] Denied*
Name of City or County Signature of City or County Official
*If the Application is denied, attach a separate sheet identifying specific reasons for the denial
Date
( )
DaytimePhone
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