The URL can be used to link to this page

Home My WebLink About2014-159 (2) III'D if DBPR ABT-6014—Division of Alcoholic Beverages and Tobacco Change of Location/Change g in Series or Type Application STATE OF FLORIDA DBPR Form DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ABT-6014 NOTE—This form must be submitted as part of an application packet Revised 07/30/2012 If you have any questions or need assistance in completing this application, please contact the Department of Business and Professional Regulation or your local district office. Please submit your completed application to your local district office. This application may be submitted by mail, through appointment, or it can be dropped off. A District Office Address and Contact/nformgiTq,," fan be found on AB&T's page of the DBPR web site at the link provided below. "FIC AT�9e b LASTPitGE http://www.myflorida.com/dbpr/abt/district offices/licensing.htm SMITH, CLERK SECTION 'I -CHECK TRANSACTION REQUESTED Transaction Type: 0 Change of Location ❑ Increase in Series ❑ Change in Series ❑ Decrease in Series Also include: ❑ Change of Business Name ❑ Retail Tobacco Products (must check one or more) ❑ Change of Officer/Stockholder/Amended Corporate Name ❑ Pipes ❑ Over the Counter ❑ Vending Machine Do you wish to purchase a Temporary License? ❑ Yes ❑ No Series Requested Type/Class Requested SECTION 2;-LICENSE INFORMATION If the applicant is a corporation or other legal entity, enter the name and the document number as registered with the Florida Department of State Division of Corporations on the line below. Full Name of Licensee: (This is the name the license is issued in) Department of State Document # BOARD OF COUNTY COMM OF INDIAN RIVER COUNTY BEV4100436 FEIN Number* Business Telephone Number 59-6000674 772-226-1410 ext Current Business Name (D/B/A)BOCC OF IRC/SANDRIDGE GOLF CLUB Current License# Series Type/Class BEV4100436 4COP SGC New Business Name (D/B/A), if applicable Location Address (Street and Number) 5300 73RD STREET CCounty State Zip Code VERO BEACH INDIAN RIVER FL 32960 Check either: ❑ Location is within the city limits or W Location is in the unincor orated count Contact Person (Optional) Telephone Number MICHAEL C.ZITO,ASSISTANT CTY ADMINISTRATOR 1772-226-1410 ext E-Mail Address (Optional) MZITO@IRCGOV.COM Mailing Address (Street or P.O. Box) 1801 27TH STREET City State Zip Code VERO BEACH FL 32960 ABT District Office Received /Date Stamp Auth.61A-3.020&61A-5.0017,FAC 1 Eff. 7/30/12 r.Y # ;5` SECTION 3' DESCRI�TION;OF PREMISE$:TQ BE LICENSED'' Business Name(D/B/A) BOARD of Co u�rr �M1 ss o nI Street Address '.9 5 ,J—8 rµ AVGNUE City VE/Zn B�Acr+ County nib SAN ��v ER State Zip Code 1. Yes ❑ No CtY Is the proposed premises movable or able to be moved? >- U 2. Yes ❑ NOT-FE— Is there any access through the premises to any area over which = you do not have dominion and control? w 3. Neatly draw a floor plan of the premises in ink, including sidewalks and other outside areas which a contiguous to the premises, walls, doors, counters, sales areas, storage areas, restrooms, bar _ o= locations and any other specific areas which are part of the premises sought to be licensed. A multi- - story building where the entire building is to be licensed must show each floor plan. SERviNa RCA v_ y) t�N W ,� 1rvD,A� 1 W59 COUN l rAIR6R0uN D5 �( r. Iv T o r y a ApProx �(,� 7AO 5F 6"", Hi 2 5p E S-ro rAG.�5 ?ao e Street Address City County State Zip Code Fl. A. The location complies with zoning requirements for the sale of alcoholic beverages or wholesale tobacco products pursuant to this application for a Series license. B. Are there outside areas which are contiguous to the premises which are to be part of the premises sought to be licensed?" ❑ Yes ❑ No L ned Date CERVI iC T{ON CN LAST PAGE J.R.SMITH,CLERK INDIAN RIVER COUNTY Environmental Planning & Code Enforcement Section 1801 27th Street, Vero Beach FL 32960 * * 772-226-1249 / 772-978-1806 fax �LoR�A www.ircgov.com 10/28/2014 APPLICANT: INDIAN RIVER COUNTY ATTN: MICHAEL ZITO 1801 27TH ST VERO BEACH, FL 32960 ALCOHOLIC BEVERAGE LICENSE ZONING PERMIT PROJECT/ PERMIT NO. 92090142/73498 PROJECT NAME: INDIAN RIVER COUNTY FAIRGROUNDS LOCATION OF ACTIVITY: 7955 58THAV PARCEL NUMBER: 31-39-32-00000-7000-00002.0 THIS ALCOHOLIC BEVERAGE LICENSE ZONING PERMIT is issued in accordance with the Indian River County Code of Laws and Ordinances. The above named applicant is authorized to perform the herein described activity in accordance with the specifications of applicable county regulations. This permit does not absolve the applicant and/or property owner from the responsibility to satisfy state or federal regulations that may apply to the activity. SPECIFIC CONDITIONS (AS APPLICABLE): 1. The subject property is described as follows: SE 1/4, LESS SE 1/4 OF SE 1/4 OF SE 1/4 & SW 1/4 OF SW 1/4 OF SE1/4 & LESS E 40 FT FOR RD R/W. 2. The subject property is currently zoned A-1, Agricultural District, which would allow for the issuance of a 4-COP (beer, wine, and liquor on-site consumption)Alcoholic Beverage License. 3. Reference Indian River County Site Plan Numbers SP-MA-83-06-074 and SP-MA-90-05-32 for site location and use. 4. There are no established schools within the five hundred (500) foot seperation distance as required by County Code Section 300.05(1). DATE OF PERMIT ISSUANCE: 10/28/2014 SIG ATURE OF AUTHORIZATION: Kell B c Cod E cement Officer In an River County abev.letter proj/permit no.92090142/73498 L!J SECTION 4—APPLICATION APPROVALS u~a Full Name of Licensee ? x: BOARD OF COUNTY COMMISSION OF INDIAN RIVER COUNTY, FLORIDA UJ Business Name(D/B/A) y- Street Address ` = 1801 27TH STREET City County State Zip Code VERO BEACH INDIAN RIVER COUNTY FL 32960 i IN Pil Ali 11:1:1 .,. . x=-- R A. The location complies with zoning requirements for the sale f alco lic beverages or wholesale tobacco products pursuant to this application for a Series license. B. This approval includes outside areas which are contiguous to the premises which re to be part of the premises sought to be licensed and are identified on the sketch?" ❑ Yes No Signed /<*, Date Stan Boling, AICP Title Community Development Director SALES TAX TO BE COMPLETED BY THE DEPARTMENT OF REVENUE The named applicant for a license/permit has complied with the Florida Statutes concerning registration for Sales and Use Tax. 1. This is to verify that the current owner as named in this application has filed all returns and that all outstanding billings and returns appear to have been paid through the period ending or the liability has been acknowledged and agreed to be paid by the applicant. This verification does not constitute a certificate as contained in Section 212.10 (1), F.S. (Not applicable if no transfer involved). 2. Furthermore, the named applicant for an Alcoholic Beverage License has complied with Florida Statutes concerning registration for Sales and Use Tax, and has paid any applicable taxes due. Signed Date Title Department of Revenue Stamp HEALTH TO BE COMPLETED BY THE DIVISION OF HOTELS AND RESTAURANTS OR COUNTY HEALTH AUTHORITY OR DEPARTMENT OF HEALTH OR DEPA TMENT OF AGRICULTURE&CONSUMER SERVICES The above establish t co a requirements of the Florida Sanitary Code. Signed Date v E itle � Agency K10 Auth.61A-3.020&61A-5.0017,FAC 3 Eff. 7/30/12 Cri SECTION 5—CONTRACTS OR AGREEMENTS Q� Business Name (D/B/A) cn These questions must be answered about this business for every person or entity listed as the applicant and copies of agreements must be submitted with this application. If the management, service, or other contractual '_`_:; agreement gives a person or entity control of the licensed premises or the sale of alcoholic beverages, disclosure of those persons must be made in the section labeled "DIRECT INTEREST" in the DISCLOSURE OF INTERESTED PARTIES section. They must also submit fingerprints and a related party Personal information sheet. 1. Yes ❑ No Is there a management contract, franchise agreement, or service agreement in connection with this business? 2. Yes ❑ No ❑ Are there any agreements which require a payment of a percentage of gross or net receipts from the business operation? 3. Yes ❑ No V Have you or anyone listed on this application, accepted money, equipment or anything of value in connection with this business from a manufacturer or wholesaler of alcoholic beverages? SECTION 6 SPECIAL LICENSE REQUIREMENTS DOES NOT.APPLYTO BEER AND WINE LICENSES Please check the appropriate"Special Alcoholic Beverage License" box of the license for which you are applying. Fill in the corresponding requirements for each Special License type. ❑ Quota Alcoholic Beverage License ❑ Special Alcoholic Beverage License ❑ Club Alcoholic Beverage License This license is issued pursuant to Florida Statutes or Special Act, and as such we acknowledge the following requirements must be met and maintained: Please sign and date: Applicant's Signature: Date: Auth.61A-3.020&61A-5.0017,FAC 4 Eff. 7/30/12 SECTION 7 DISCLOSURE OF INTERESTED PARTIES" Note: Failure to disclose an interest, direct or indirect, could result in denial, suspension and/or revocation of C t3 Our license. Cl Business Name (D/B/A) �- e. 1. When applicable, please complete the appropriate section below. Attach extra sheets if necessary. Title/Position Name Stock % 0- ,_ CORPORATION (CORP/INC) 'a President U., - Vice President _Y Secretary Treasurer Director(s) Stockholder(s) LIMITED LIABILITY COMPANY LLC/LC Managing Member(s) and/or Managers Members (must be printed if there are no managing members or mans ers LIMITED PARTNERSHIP (LTD/LP/LTDLLP) General Partner(s) Limited Partner(s) Bar Manager(Fraternal Organizations of National Scope only): DIRECT INTEREST Name of Individual or Entity (If a legal entity, list name under which the entity does business and its principles) Title/Position Name Stock% 2. Are there any persons not listed above who have guaranteed or co-signed a lease or loan, or any person or entity who has loaned money to the business that is not a traditional lending institution? ❑ Yes ❑ No If yes, and the terms create a direct interest in the business, you must list the person(s) or entity and indicate which of the below applies. Each directly interested person must submit fingerprints and a related party personal information sheet. Copies of a reements must be submitted with this application. Name Guarantor Co-signer Lender Interest Rate List Auth.61A-3.020&61A-5.0017,FAC 5 Eff. 7/30/12 SECTION 8-AFFIDAVIT OF APPLICANT NOTARIZATION REQUIRED Business Name(D/B/A) BOARD OF COUNTY COMMISSION OF INDIAN RIVER COUNTY "I, the undersigned individually, or if a registered legal entity for itself and its related parties, hereby swear or affirm that I am duly authorized to make the above and foregoing application and, as such, I hereby swear or affirm that the attached sketch is a true and correct representation of the premises to be licensed and agree that the place of business, if licensed, may be inspected and searched during business hours or at any time business is being conducted on the premises without a search warrant by officers of the Division of Alcoholic Beverages and Tobacco, the Sheriff, his Deputies, and Police Officers for the purposes of determining compliance with the beverage and retail tobacco laws." "I swear under oath or affirmation under penalty of perjury as provided for in Sections 559.791, 562.45 and 1837.06, Florida Statutes, that the foregoing information is true and that no other person or entity except as indicated herein has an interest in the alcoholic beverage license and/or tobacco permit, and all of the above listed persons or entities meet the qualifications necessary to hold an interest in the alcoholic beverage license and/or tobacco permit." STATE OF FLORIDA COU OF INDIAN RIVER .•''•�1MIS '• C AG0 OAF ��` /� row •9s*. APPLICANT SIGNATURE ; : Peter D. O'Bryan, Chairman y,;•., APPLICANT SIGNATURE •. N'''•� -''rt•,•••• • ��•.R/VEfl C0��•. The foregoing was ( ) Sworn to and Subscribed OR (Acknowledged Before me this Day t of lfelnn�,f 20 7 By:pp— of�. 0 f�1�1 on who is (y, -personally ( rint name(s) of person(s making statement) known to me OR ( ) who produced as identification. LAURA E VASCIUEZ * * MY COMMISSION A EE 123140 n Commission Expires: U oQo/S N u b I is '+� ��' Bonded TM eu*NoWy Sw*a STATE OF FLORIDA .•"'�ppIERS• '" INDIAN RIVER COUNTY •"•�S`'.•••••• ...•.'f ''+ THIS IS TO CERTIFY T AT THIS IS r=V�r' •'.:o`; A TRUE AND CORRE C Y THE ORIt31 L O T IS t;; OFFICE. J SMITH DATE `�' ... ... X Auth.61A-3.020&61A-5.0017,FAC 6 Eff. 7/30/12