CARBON COUNTY
APPLICATION FOR LICENSE TO SELL ALCOHOLIC BEVERAGES

 Date:___________________

HONORABLE BOARD OF COUNTY COMMISSIONERS:

I, [we] ___________________________ doing business as _____________________________

Name of Applicant(s)  Name of Business

at _____________City                         ST                              Zip ,hereby make application
       Business Address

for a license to sell:

___ Class "A" retail     ___ Class "B" retail     ___ Class "C" retail

              ___ Class "D" retail      ___ Wholesale             __ Liquor Consumption

for the period from _____________________________ to _________________________________ If a co-partnership, names and addresses of all officers, owners, and/or directors must be listed below.

NAME                                                     ADDRESS
______________________                    ___________________________
______________________                    ___________________________
______________________                    ___________________________
 

I am a citizen of the United States, over the age of 21 years, and have never been arrested or convicted of a felony, except as herein stated:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________


If a license is granted, I (we) swear to obey the laws of the State of Utah and the County of

Carbon, and will comply with all provisions of Carbon County Ordinance No. ____ And the Utah Liquor Control Act. I (we) understand that the license is subject to revocation as provided in Section _______ of Carbon County Ordinance No. _____

_____________________________                                                _______________________________
Signature of Applicant Home                                                                 Address

_____________________________                                                _______________________________
Signature of Applicant Home                                                                 Address

NOTICE

To engage in the business for which this license is issued, you must comply with all county health and safety codes, including those relating to zoning, building, health, and fie safety. If now, or in the future, you do not comply with these codes, this license does not authorize you to engage in business.

APPROVED:

____________________________                        _______________________
                                                                                        Carbon County Sheriff
____________________________                       

____________________________                        _______________________
Carbon County Commissioners                                                                        Southeastern Utah Health District