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Liquor License Transfer of Service_Rotary Club of DubuqueABD Licensing - Applicant n Page 1 of 1 Cht State of Iowa ALCOHOLIC BEVLROa DIVISION • About • Alcohol • Tobacco • Links • Contact ' Help License Search On- Demand Keg Registration 1 License List Reporting _ Search . User Profile Logoff Applicant Applicant BW0092633, Rotary Club of Dubuque, Dubuque Transfer Premise After completion click on the NEXT link to continue to the next screen, or the BACK link to return to the previous screen. New Premise Location Information The navigation links on the top may also be used to move around the application. Applicant Signature Name of Applicant: IRotary Club of Dubuque (Sole Proprietorship. Partnership, Corporation, etc.) • Dram Cert Name of Business (D /B /A): (Rotary Club of Dubuque Local Endorse Address of Premise:1135 W 8th St Address Line 2:1 City Dubuque County: I Dubuque Zip: 152001 Business Phone: 1(563) 589 -2234 Cell I Home Phone: I ? Same Address Mailing Address:IP 0 Box 813 Mailing Address Line 2:I City: 'Dubuque Zip:152004081 Contact Name: 'Mike Loveless Phone:1(563) 584 -9235 Email Address: Imloveless @lovelesslns , com A Prey Next :t 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 02009 State of Iowa Alcoholic Beverages Division All Rights Reserved State: I Iowa J https://elicensing.iowaabd.com/Applicant.aspx 04/29/2011 ABD Licensing - Transfer Premise Page 1 of 1 ) Applicant Transfer Prern:se New Premise Location Information • Applicant Signature Dram Cert Local Endorse State of Iowa ALCOHOLIC BEVE ,$ DIVISION Help License Search License List On- Demand Keg Registration User Profile I� Logoff Reporting Search Transfer Premise BW0092633, Rotary Club of Dubuque, 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. 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: Rotary Club of Dubuque Name of Business (D/B /A): Rotary Club of Dubuque Address of Premise: 135 W. 8th St. Address Line 2: City: Dubuque New Premise Address: IAY McDonald Park • About • Alcohol • Tobacco • Links • Contact New Premise Address Line 2: IKerper Boulevard at Hawthorne Street and Volunteer Drive State: City: I Dubuque ..1 Ilowa C Temporary Transfer (24 hours through 7 days) Beginning Date: 106/09/2011 Ending Date: 106/09/2011 Beginning Date: I Prey Next :? Follow us with RSS, Facebool or Twitter C Permanent Transfer Contact Us Iowa Alcoholic Beverages Division 1918 SE Hulsizer Road Ankeny IA 50021 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 County: Dubuque Zip: 52001 Zip: 152001 https://elicensing.iowaabd.com/TransferPremise.aspx 04/29/2011 ABD Licensing - New Premise Location Information Page 1 of 1 Applicant Transfer Premise • New Premise Location Information • Applicant Signature Dram Cert / Local Endorse I4 I1 State of Iowa ALCOHOLIC BEVEfiA .$ DIVISION • About • Alcohol • Tobacco • Links • Contact On- Demand Keg Registration I, Help ( License Search Reporting Search j. License List User Profile I Logoff New Premise Location Information BW0092633, Rotary Club of Dubuque, 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. # of Bathrooms: Number of floors where alcoholic beverages will be sold, served, consumed and stored. Indicate how you have control of premises (Permanent Transfers Only): C Own C 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: 106/09/2011 MM /DD/YYYY To:106/09/2011 MM /DD/YYYY applicable): Dates shall correspond with requested outdoor service areas. On- Premise Applicant's Only: I Yes z Is the premise furnished with tables and seats to accomodate a minimum of 25 persons at one time? i5.I Prev Next L 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 /NewPremiseLocationInformation .aspx 04/29/2011 ABD Licensing - Applicant Signature Page 1 of 2 3 Help Applicant 7 Transfer Premise ' New Premise Location Information • Applicant Signature Dram Cert Local Endorse State of Iowa ALCOHOLIC BEVLRAQLS DIVISION • About • Alcohol • Tobacco • Links • Contact License License j' On- Demand Search List Reporting K eg Registration User Profile I' Logoff Search i._____._..__..__ Applicant Signature BW0092633, Rotary Club of Dubuque, 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: lAmy Weber Date: 104/2$/2011 MM /DD/YYYY Tentative effective date: 106/09/2011 MM /DD/YYYY Please print a copy of this page for your records before clicking the "FINISH" button. !t! Prey https: / /eicensing. iowaabd .com /ApplicantSignature.aspx 04/29/2011 ABD Licensing - Applicant Signature Page 2 of 2 Follow us with RSS, Facebook or Twitter Contact Us Iowa Alcoholic Beverages Division 1918 SE Hulsizer Road, Ankeny, IA 50021 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 04/29/2011