Liquor License Transfer Rotary Club
SEP-18-2006 03:06 PM CENTURY 21 REALTORS
563 583 3579
P.02
a
1_ ALCOHOLIC
BEVERAGES
DIVISION
a.,.. If 'OWI
T........ J. vu.... Govemcr of low.
Silly J. Ptcleroon L1eul81li111l Govemot
Lynoll. Wilding "_rOIOf
TRANSFER ApPLICATION
Licenses may be Iraniferredfram ane 1~/2tion ta anolher, bul ani)' within th. bou>uiarics of Ihe curnnl appruving Local
Official. The Trilnsfer ApplU:iI/;an an,lI illI s..pportine doc....entiltinn .,/rp/l I>e I/pprovlld by Ih.. Lacal Official "nil
forwarded 112 the Iowa Ai<:oho/ic Beveragu Division befon the ."",,1 ,,,1,,. place. All selling and s/lrving of alcaholic
bew,'a8'" 'nUSI ~_e al the original /teeMed locolion during rhe period "I the "",..fer. NOTE: 1/ requesti"K a
permanenllran.sjer. an amended license will be jO/WQrded 10 the Local OjJit:iul. .If reques/inl/ a lemporary trall.<fer, a
leller of permission wl/f be forwarded 112 Ihe Locol OjJicial.
LieeDBe Number: _BiQ/)()q d 0 ~ 3
NItIIO of AppIil:IDI:
(Sole P>...........ip. ~ CaopoIat.... ....)
N..... of BIl.ine.. (D/BI^~
. 00 I
Ziph <;' ;;>.~ I
, 1. ~IC.m.
.. '..
Addr... ofPmni...: ~
City:
'1. NEW~E ADDRESS.
City:
{- u:bt r ~1?U-
Phoao: 4'::,17 f- 5K&--73;)X
Addteu of Propooed PrcnIiIe:
3. TRANSFER DATE.
T....,.,.vy Ttllllf.. (24 boars tbroIlah 7 days);
R'll,nninB Dato' Ot!f. t<fr d/Jft; Ending Dote: Ocl. /~ .;;JOcJC" (DiI,eo mUD loll wlt.'n II..... ".'104).
o PCl1lJllnent "....fOT (mOre than 7 days): Ikllinning natc;
On-Premise Aot1llt:anlS Onll"
Dram Shop Uability Certificate of IDIlllanco Dotoo: From:
(r,.rt~fi(o"" tI",.-., s,.,,1I l~d,.t"$""lI.d wi,. rp.'1&uI1,pd ',un..',,. daU!1.
/"SMro"Ce. Ac""nI Certlflcales ".'4cceptetl)
Ihn);
Anilch copy 01 Drilm Shop LlilhUity Cerrlflcilto "J
www.IowaABD.com
Iowa Alcnbnlic Rev""",. Divi.ion, 1918 SE Hulsi2t:r Road, Ankeny, Iowa 50021 515.281.7430 866.JowaABO 866.469.2223
SEP-16-2008 03:07 PM CENTURY 21 REALTORS
4: PRE1\'f1SE lNFORMA TlON.
563 563 3579
P.OI
Page 2
All AooliCQllts:
.-1. _~~ NumberofbathroollVl.
.-2. ! Number o( floors where alcoholi. beverages will be sold, ..".,ed, .onsumed and stored.
.-3. Indi.al. bow you have control o(the premi... (p.."'.....nl Tr.IlOC", ollly): 0 Own ~ Leue
Submil ~ copy oC lhe le..elremal ape.menl Cor the Iieon... period or .ifln~4 r....l.al.. Conlnel or worraDIy d..cl.
...... Altsch a sbleh on 8 ~ x I I" wbile paper ofthe proposed premi... .hnwing .11 are.. and fIo0r0 where alcoholic beverage'
will be sold" served, consumed and stored. Indicate an cntnmce, and niLS, Jocatioo of bar, back bar .od hathroom,. U
Appli.anl ba. Outdoor Scrvic. Arc. Privil.Ce. plea.. include iJllhe .kelch it. T.latinnsbip 10 the li..".ed premiae.
4-5. Outdoor Service Ar.. 0.... (iC applicable): From:
To:
.... Alt.ch oriAi...1 Dram Shop Eodo....mcnl Dota .hall cn='f'OO<! "'Ith [_.Ied uuldwr service area dales. (^ccoul
t.:ertilica... are not accepled)
O,,~p,.emls~ ADDllc.1I11 O",~:
4-7. 0 V D N IIlhe premiaefurnished with Iabl.. and ...11 to a.commodate a minimum of25 penons at one rime?
OH-Pr~"B~ ADlIlic"",. o..'v.:
.....
(e1.11 C JJ.., App/icanu only). Sqw.re foo.... of the entire r...i1 sal.s area o( the buune.., inclndins ...... o(
walk-in <DOlen lbot or. .c....ible: 10 the public. n,i. includea all area. Wbere non.alcohol p<_ are 0100
sold. Do no. include ..eas that ar. not acc.ssibl. 10 the public: (om.... bsthroom. kitchen. slOr.ge area.. elC.).
.-9.
(Clan ELI""" Applieo"u 0,,1y). Square fOOlag. oflh. entir. interior .rea of the buildins including. bUI nol
limited 10, all.r.a.....d in the storagc, distribution, warehOusing, display. wholesale: aad rclOilsale: of
merchandise, offic:r:a. "throomR, hreak mmM, et(':.
S. APPUCA,NTS1GNATIJllE.
The Trans'er Applicllllo.. sb.1I be signed by a pe....on li.led in the O"...rsltip Seer;'.. of the oriainal licenae Application.
Starqled IipIIW'ea ue Dot acceptable.
j"edi"rMAppli lio,,' rrtI.a"dcorr7'l;!r.JQeII!:.Lo~s::::.
Do'" Print Applicant'. Name
TIll' docum.,,/ iI"'I1;<<llo Iowa', Ope" R<cord low. ''''ormarlon tonlained i1t "'. Applleotif>n m"}' "" dile/osed wi/ItoNI prior
nOrlCl /I)()r p.rmlSslOnjrom rheAppl(can/. Se, Iowa Cod.elts. 22 anJ J13. oia_ 185 Iowa Admini...rori"" Cod...1t 11/.
6. ENDORSEMENT OF LOCAL AUTHORITY.
I h.r.by .enicy tha.,he T'ansfer Appliear;... was submined 10:
CilY Coun.il or County Boord of Supervisors
011
Dal.
II i. recommended lhal the T,alr$fer be:
O."door S.rv;c~ Ar~1I (if applicable):
o Al'f'rRyad 0 n.nled'
o Appro.ed 0 Denied-
Name of City or County
Signature of City or County Official
( )
Daytime Phone
'If rlt. Appliea/;on Is d.n/.d, a"aeh . sep.,.u shutld.ntifyi", specific re...,ns for Ihe 41!1fu.L
SEP.25200612:19PM
563 589 2261_ 1501
NO. 3894_P 2
'"
15.5 11.751
. , . X l
25 I
i
16.75 L__....,.,
. . . .
16.75
.
Emergency Exit 1
16.75
. . . . . .
..._~ '.. " ,
IV
. 971
14 ..
.
",
i
. rJ
. . .. . . I . .
14 15.25 15.25 15.25 15.25 15.25 15.25 15.25 15.25
16.75
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1
,
16.75
IElevl
1._."""'........_........
EntryiExi~
16
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. . .
4 Bathrooms
Truck docks
16.75
. .
; 16'
16.75
. .
.
17
.
15.5
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Jackson Sf
1201