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 30TH 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