300 Washington Street
Brookline, MA 02445
Phone : 617-383-6000 * Fax : 617-383-6001
Liquor License Information
A. COMPANY INFORMATION:
1. Name of the Company:
2. Corporate Address:
3. Federal ID Number:
B. MANAGER INFORMATION:
1. Name of (Proposed) Manager:
2. Social Security Number:
3. Home Street Address:
4. Area Code and Telephone Number (day/home)
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5. Place of Birth:
Court and Date of Naturalization (if applicable)
6. Date of Birth:
7. Are you a Registered Voter?
YES
NO
8. Are you a U.S. Citizen?
YES
NO
Court and Date of Naturalization (if applicable)
9. Father"s Name:
10. Mother"s Maiden Name:
11. Hours per week to be spent on the Licensed Premises:
12. Driver"s License Number:
13. Height / Weight / Eye Color (For Criminal CORI request)
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14. Criminal History (if applicable)
15. Place of Employment:
16. Have you been a manager of record before?
YES
NO
If yes, when/where?
17. Do you have prior experience in the liquor industry?
YES
NO
If yes, please include in your Resume.
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18. Describe your financial interest, direct or indirect, in any other liquor license, permit or certificate:
C. PREMISES INFORMATION:
1. Description of Layout: (floors, bar, bathrooms, etc. )
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2. Occupancy Number:
3. Number of Seats:
4. Square Footage:
5. Number of Entrances and Exits:
6. Hours of Operation:
D. DOCUMENTS NEEDED:
LEASE
YES
NO
If not available, reason why?
Floor Plan
YES
NO
If not available, reason why?
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Submit
Should be Empty: