Home Page: Bartender License Form

Town of Dewey, Portage County, Wisconsin

Operator (Bartender) License Application

 

 

(   )  New

(   ) Renewal

(   ) 1 year - $10.00

(   ) 2 year - $20.00

            NOTE: ALL LICENSES EXPIRE JUNE 30^TH OF EACH YEAR

 

 

Complete legal name on your driver’s license            Last          First      Middle            Maiden           

Current address           Number & Street                      City                             State                Zip

Date of birth                         Phone Number                        Name of Tavern were you plan to work

 

 

Y  or  N           I am 18 years old or older.

 

Y  or  N           I have a felony conviction.

 

Y  or  N           I have pending criminal charges.

 

Y  or  N           I am a registered sex offender.

 

Y  or  N           I have had an OWI conviction within the past 12 months.

 

Y  or  N           I have had three or more OWI convictions in the past 36 months.

 

Y  or  N           I have had criminal convictions that occurred on any premise licensed for the sale of                           alcohol.

 

Y  or  N           I have had a possession of a controlled substance conviction.

 

Y  or  N           I permit the Town of Dewey to complete a criminal history investigation.

 

Y  or  N           I understand and agree that a false statement will result in denial of this application.

 

Applicant’s Signature                                                 Date