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Liquor License Transfer_Choppers Ten Pin Tap, LuGrainABD Licensing - Applicant State at Iowa ALCOHOLIC BEVEYKALS DIVISION • About • Alcohol • Tobacco • Links • Contact I Help License Search License List . On- Demand 1, Keg Registration User Profile L off Reporting Search Applicant LC0029828, PJ's Tap, Dubuque > Applicant • Transfer Premise = New Premise Location Information • Applicant Signature • Dram Cert > Local Endorse After completion click on the NEXT link to continue to the next screen, or the BACK Zink to return to the previous screen. The navigation links on the top may also be used to move around the application. Name of Applicant: 'LuGrain, Lana Kaye Name of Business (DIB /A): Address of Premise: 500 Rhomberg Address Line 2: City: Dubuque County: Dubuque Zip: 52001 Business Phone: :563) 556 -9666 17 Same Address Mailing Address: 1500 Rhomberg Mailing Address Line 2: I City: 1Jubuque Zip: 152001 Contact Name: 'Lana Phone: 1( 563) 556 -9666 Email Address:' Prev Next >1 Follow us with RSS, Facebook or Twitter Contact Us Iowa Alcoholic Beverages Division 1918 SE Hulstzer Road, Ankeny, IA 50021 Toll Free 866.IowaABD (866.469.2223) Local 515 281 7400 • Terms and Conditions • Privacy Policy Copyright 02009 State of Iowa Alcoholic Beverages Division All Rights Reserved. -r 500 - 0-fu.LAA1 - to Coos V--01,(A-e-k-r R eAv—euvLe,vv — C ---- (Sole Proprietorship, Partnership, Corporation, etc.) Page 1 of 1 // (e S Cell1 Home Phone: 1( 563) 583 -1480 State:' Iowa https: / /elicensing .iowaabd.com /Applicant.aspx 01/11/2011 ABD Licensing - Transfer Premise Page 1 of 1 I f r [ On- Demand ' Keg Registration 1. r Help 1 License Search License List II Reportinn L Search User Profile Logoff Transfer Premise LC0029828, PJ's Tap, Dubuque x Applicant • Transfer Premise a New Premise Location Information s Applicant Signature > Dram Cert s Local Endorse After completion click on the NEXT Zink to continue to the next screen, or the BACK link to return to the previous screen. The navigation links on the top may also be used to move around the application. 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. Name of Applicant: Name of Business (D /B /A): Address of Premise: Address Line 2: City: LuGrain, Lana Kaye PJ's Tap 500 Rhomberg Dubuque New Premise Address: 1601 Rhomberg Ave New Premise Address Line 2: 1 City: Dubuque Prev State of lowa ALCOHOLIC BEVi;RAQAS DIVISION • About • Alcohol • Tobacco • Links • Contact Temporary Transfer (24 hours through 7 days) Beginning Date: 1 Permanent Transfer Beginning Date: 101/26/2011 Follow us with RSS, Facebook or Twitter MEI Contact Us Iowa Alcoholic Beverages Division 1918 SE Hulsizer Road, Ankeny, IA 50021 Toll Free 866.IowaABD (866.469.2223) Local 515 281.7400 • Terms and Conditions • Privacy Policy Copyright ©2009 State of Iowa Alcoholic Beverages Division All Rights Reserved County: Dubuque Zip: 52001 State: 1 Iowa Ending Date: 1 Zip: 152001 Next https://elicensing.iowaabd.com/TransferPremise.aspx 01/11/2011 ABD Licensing - New Premise Location Information Page 1 of 1 Help r On- Demand Ke g Registration istration License Search , License List User Profile Logoff ! Reporting Search a Applicant s Transfer Premise x New Premise Location Information y Applicant Signature s Dram Cert Local Endorse State et loioa ALCOHOLIC BEVLRACAES DIVISION New Premise Location Information LC0029828, PJ's Tap, Dubuque After completion click on the NEXT link to continue to the next screen, or the BACK link to return to the previous screen. The navigation links on the top may also be used to move around the application. 1 2 # of Bathrooms: 1 1 Number of floors where alcoholic beverages will be sold, served, consumed and stored. Indicate how you have control of premises (Permanent Transfers Only): f Own f Lease Submit to the Local Authority a signed copy of the lease /rental agreement for the license period or signed final sales contract or warranty deed. Submit to the Local Authority a sketch on 81/2 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. If Applicant has Outdoor Service Area Privilege, please include in the sketch its relationship to the licensed premises. Outdoor Service Area Dates (if From: I MM /DD/YYYY To: I MM /DD/YYYY applicable): Dates shall correspond with requested outdoor service areas. On- Premise Applicant's Only: I Yes r : . t Is the premise furnished with tables and seats to accomodate a minimum of 25 persons at one time? +1 Prev Next • About • Alcohol • Tobacco • Links • Contact Follow us with RSS, Facebook or Twitter Contact Us Iowa Alcoholic Beverages Division 1918 SE Hulsizer Road, Ankeny, IA 50021 Toll Free 866.IowaABD (866.469.2223) Local 515.281.7400 • Terms and Conditions • Privacy Policy Copyright ©2009 State of Iowa Alcoholic Beverages Division. All Rights Reserved. https: / /eicensing. iowaabd. com /NewPremiseLocationlnformation .aspx 01/11/2011 ABD Licensing - Applicant Signature Page 1 of 2 $ Applicant i Transfer Premise • New Premise Location Information 2 ' Applicant Signature • Dram Cert • Local Endorse State of Iowa ALCOHOLIC BEVEJ A S DIVISION • About • Alcohol • Tobacco • Links • Contact 1 ' j r On- Demand Keg Registration , Help ' License Search is License List ,; User Profile ' Logoff Reporting Search Applicant Signature LC0029828, PJ's Tap, Dubuque Complete the information below and click Finish to complete the application Note that the license fees will only be withdrawn from accounts after the ABD approves the license. This application must be completed by a person listed in the Ownership Section. I hereby declare that all information contained in the Application is true and correct. I understand that misrepresentation of material facts in the Application is a crime and grounds for denial of the license or permit under Iowa law. I further understand that, as a condition of receiving a license, the licensed premises is subject to inspection during business hours by appropriate local, state and federal officials. NOTE: The Applicant's Name must match one of the owner's names from the Ownership screen. Applicant's Name: 'Lana LuGrain Date: 111/22/2010 MM /DD /YYYY Tentative effective date: 101/26/2011 MM /DDIYYYY Please print a copy of this page for your records before clicking the "FINISH" button. Ics Prev Follow us with RSS, Facebook or Twitter Contact Us Iowa Alcoholic Beverages Division 1918 SE Hulsizer Road, Ankeny, IA 50021 https: / /eicensing. iowaabd .com /ApplicantSignature.aspx 01/11/2011 ABD Licensing - Applicant Signature Page 2 of 2 Toll Free 866.IowaABD (866.469.2223) Local 515.281.7400 • Terms and Conditions • Privacy Policy Copyright ©2009 State of Iowa Alcoholic Beverages Division. All Rights Reserved. https: / /elicensing. iowaabd .com /ApplicantSignature.aspx 01/11/2011 ABD Licensing - Applicant Signature Page 1 of 2 On- Demand Keg Registration ?; Help j: License Search License List I Reporting Search LI User Profile , z Applicant x Transfer Premise • New Premise Location Information • Applicant Signature • Dram Cert s Local Endorse Applicant Signature LC0029828, PJ's Tap, Dubuque Complete the information below and click Finish to complete the application Note that the license fees will only be withdrawn from accounts after the ABD approves the license. This application must be completed by a person listed in the Ownership Section. I hereby declare that all information contained in the Application is true and correct. I understand that misrepresentation of material facts in the Application is a crime and grounds for denial of the license or permit under Iowa law. I further understand that, as a condition of receiving a license, the licensed premises is subject to inspection during business hours by appropriate local, state and federal officials. NOTE: The Applicant's Name must match one of the owner's names from the Ownership screen. Applicant's Name: (Lana LuGrain Date: 111/22/2010 MM /DD /YYYY Please print a copy of this page for your records before clicking the "FINISH" button. 'st Prev State at Iowa ALCOHOLIC BEVLRAU,S DIVISION • About • Alcohol • Tobacco • Links • Contact Tentative effective date: 101/26/2011 Follow us with RSS, Facebook or Twitter Contact Us Iowa Alcoholic Beverages Division 1918 SE Hulsizer Road, Ankeny, IA 50021 Logoff 1 MM /DD /YYYY https: / /elicensing.iowaabd .com/ApplicantSignature.aspx 01/11/2011 ABD Licensing - Applicant Signature Page 2 of 2 Toll Free 866.lowaABD (866.469.2223) Local 515.281.7400 • Terms and Conditions • Privacy Policy Copyright ©2009 State of Iowa Alcoholic Beverages Division. All Rights Reserved. https: / /eicensing. iowaabd .com /ApplicantSignature.aspx 01/11/2011