Beer Permit Application

City of Dickson, Tennessee

Beer Permit Application
The City Recorder’s Office is responsible for all beer permits issued within the city limits of Dickson.

Only completed applications will be submitted to the beer board. Please complete all questions on the application accurately.

The beer board requires the applicant or a representative of the applicant be present at the beer board meeting.

The City of Dickson Beer Board considers applications at its first meeting after receipt of completed application and results of background check.

The City Recorder will notify you when to appear.

After approval of the permit, the applicant must pay the annual privilege tax before the beer permit is issued.

If you have any questions, please contact Kimberly Givens at 615-441-9508 or kgivens@cityofdicksontn.gov.
City of Dickson - Beer Permit Process

1. Secure compliant location (determine if a survey is required).

The City of Dickson has a distance requirement of 400 feet from any church or school. A survey from a licensed surveyor must accompany the application. The distance restriction does not apply to:
- An establishment having a license issued by the Tennessee Alcoholic Beverage Commission to sell alcoholic beverages for consumption on the premises and which is a restaurant as defined by the Tennessee Alcoholic Beverage Commission pursuant to Tennessee Code Annotated § 57-4-101, et seq.
- An establishment having a license issued by the Tennessee Alcoholic Beverage Commission to sell wine and which is a retail food store as defined by the Tennessee Alcoholic Beverage Commission pursuant to Tennessee Code Annotated § 57-3-803, et seq.
- An establishment located in an area zoned commercial
2. Return completed and notarized application and other required documents to the City Recorder.

3. Pay $250.00 non-refundable application fee

4. Background check conducted by the Tennessee Bureau of Investigation

5. Business must have a current City of Dickson business license

6. Business must have Department of Revenue Sales and Use Tax Certificate or must provide proof application has been made

7. Class I and Class III permit applicants are required to provide a copy of their menu

8. After permit is approved a pro-rated privilege tax must be paid to the City of Dickson Tax Collector’s office before beer permit is issued by the City Recorder.

9. For proof of identification, the applicant must bring their driver’s license and social security card (or other form of government issued identification) when application is submitted. A copy must be on file with their application.

10. Beer permit will not be issued until building has met all building codes and a Certificate of Occupancy has been given by the City of Dickson Planning and Zoning Department.
City of Dickson - Beer Permit Information

Beer permits are issued by the City of Dickson Beer Board. Temporary permits are not issued. (For information regarding beer permits and their restrictions, please see the attached Municipal Code entitled “Beer” (Title 8, Chapter 2 Section 8-209).

Permits are issued to the owner of the business, whether a person, firm, corporation, joint-stock company, limited liability corporation, syndicate, or association.

A permit is only valid for the business owner named in the permit application.

A permit is issued for a single location and is valid for all decks, patios, and other outdoor serving areas that are contiguous to the exterior of the building in which the business is located.

If the business operates through a local managing agent and the owner changes managing agents, the business is required to send the “Change of Managing Agent” Form that is provided in the packet to notify the City of Dickson of the change in managing agents.

When a business is terminated, a change of ownership occurs, relocation of the business, or there is a change in the business name, the permit holder must return the permit to the City of Dickson within fifteen (15) days of the change. (A change in ownership occurs for a corporate owner when at least 50% of the stock of the corporation is transferred to a new owner.) A new beer permit must be applied for when the above listed changes occur.

Periodic renewal of beer permits is not required.

The City of Dickson has a distance requirement of 400 feet from any church or school. A survey from a licensed surveyor must accompany the application. The distance restriction does not apply to:

1)   An establishment having a license issued by the Tennessee Alcoholic Beverage Commission to sell alcoholic beverages for consumption on the premises and which is a restaurant as defined by the Tennessee Alcoholic Beverage Commission pursuant to Tennessee Code Annotated § 57-4-101, et seq.

2)   An establishment having a license issued by the Tennessee Alcoholic Beverage Commission to sell wine and which is a retail food store as defined by the Tennessee Alcoholic Beverage Commission pursuant to Tennessee Code Annotated § 57-3-803, et seq.

3)   An establishment located in an area zoned commercial

A non-refundable application fee of $250.00 must be paid to the City of Dickson

The beer privilege tax is $100.00 per year and is due January 1st of each year. (A prorated amount must be paid by new permit holders)

Applicants must have a current City of Dickson Business License and provide proof of Department of Revenue Sales and Use Tax Certificate or proof application of certificate has been applied for by the applicant.

Applicants must submit a background check and be fingerprinted through the Tennessee Bureau of Investigation. Each owner with ownership of 5% or more is required to submit a background check. Corporate ownership should include background checks on each principal officers and local managing agent(s). (Information regarding required background check and fingerprinting is provided on the last page of this packet.)

A local background check will also be performed by the City of Dickson Police Department. (City Recorder will request the local background check by the City of Dickson Police Department.)

All municipal building requirements must be met and a Certificate of Occupancy (C.O.) must be given by the City of Dickson Planning and Zoning Department before a beer permit is issued.

All applications must be complete and all required documentation must be turned in to the City Recorder before an application is sent to the beer board. Applications and required documentation will be reviewed by the City Recorder. Once all requirements for the application have been met, the City Recorder will contact the applicant to inform them date and time of the beer board meeting. The beer board requests the applicant be present at the board meeting to answer any questions the board may have.
For questions regarding this application, contact City Recorder Kimberly Givens at kgivens@cityofdicksontn.gov or at 615-441-9508.
Applicate Confirmation #1
Applicant Confirmation #2
Applicant Confirmation #3

I also know and understand: When a business is terminated, a change of ownership occurs, relocation of the business, or there is a change in the business name, the permit holder must return the permit to the City of Dickson within fifteen (15) days of the change. (A change in ownership occurs for a corporate owner when at least 50% of the stock of the corporation is transferred to a new owner.) A new beer permit must be applied for when the above listed changes occur.
Applicate Confirmation #4
City of Dickson - Beer Permit Application
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Applicant Information
Name of Applicant (Owner)

First NameLast Name
Applicant is:
Applicant's Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Applicant's Date of Birth
Applicant's Driver's License Number
Applicant's Social Security Number
Applicant must submit two forms of identification as proof of identity. A driver’s license and social security card (or other form of government issued identification) must be sent with your application.
Proof of Identification1

Cancelof
Proof of Identification2

Cancelof
Business Information
Address of Business

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
City of Dickson Business License Number
Type of Permit Requested:

Class V: Growler Permit. This permit shall allow the retail sale of beer contained in “growlers.” A “growler” is defined as a glass container not to exceed sixty-four (64) ounces that is filled by an employee of the licensed establishment with beer from a keg. The container must be specifically manufactured, sold and utilized solely for the purpose of a “growler” and must be re-sealable for off-premises consumption only. “Growlers” may only be filled from kegs procured by the licensee from a duly licensed wholesaler. Only professionally sanitized and sealed “growlers” may be filled and available for retail sale. Each “growler” must be securely sealed and removed from the premises in its original sealed condition.
Annual Privilege Tax Contact Information

$100.00 per year - mailed on November 1 - due January 1
Person To Recieve Annual Privilege Tax Notices

First NameLast Name
Address To Send Annual Privilege Tax Notices

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Ownership

Persons or business entities having at least a five percent (5%) ownership interest in the applicant business, and, if a business entity owns at least a five percent (5%) ownership interest in the applicant business, the owners of at least a five percent (5%) ownership interest in such business entity shall also be disclosed;
List all persons, firms, corporations, joint-stock companies, syndicates, partnerships or associations having at least a five percent (5%) ownership interest in the business

First NameLast Name
List all persons, firms, corporations, joint-stock companies, syndicates, partnerships or associations having at least a five percent (5%) ownership interest in the business

First NameLast Name
List all persons, firms, corporations, joint-stock companies, syndicates, partnerships or associations having at least a five percent (5%) ownership interest in the business

First NameLast Name
List all persons, firms, corporations, joint-stock companies, syndicates, partnerships or associations having at least a five percent (5%) ownership interest in the business

First NameLast Name
List all persons, firms, corporations, joint-stock companies, syndicates, partnerships or associations having at least a five percent (5%) ownership interest in the business

First NameLast Name
List all persons, firms, corporations, joint-stock companies, syndicates, partnerships or associations having at least a five percent (5%) ownership interest in the business

First NameLast Name
Owners Background Information

A TBI Background Check is REQUIRED for anyone with at least 5% (five percent) ownership
Has the prospective permit holder or anyone having at least a five percent (5%) ownership interest, managers or employees of the business been convicted within the past ten (10) years of any felony involving misuse or abuse of alcohol or the illegal use of drugs, or any violation of the laws against possession, sale, manufacture for sale, or transportation of beer or other alcoholic beverages, or the manufacture, delivery, sale, or possession with intent to manufacture, deliver, or sell any controlled substance that is listed in TCA § Title 39, Chapter 17, Part 2, schedules I through V, et seq., and/or any crime involving moral turpitude?
Name of Person Convicted

First NameLast Name
List Specific Charge
Name of Court
Address of Court

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Convicted

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Has the prospective permit holder or anyone having at least a five percent (5%) ownership interest, managers or employees of the business been convicted within the past two (2) years of any misdemeanor involving the misuse or abuse of alcohol or the illegal use of drugs, including, but not limited to, driving under the influence or while impaired, public intoxication, as defined in TCA §39-17-310, et seq., disorderly conduct when it involves the use of alcohol or the illegal use of drugs, and/or any violation of the laws against possession, sale, manufacture for sale, or transportation of beer or other alcoholic beverages, or the manufacture, delivery, sale, or possession with intent to manufacture, deliver, or sell any control substance that is listed in TCA Title 39, Chapter 17, Part 2, scheduled I through V, et seq., and/or any crime involving mora turpitude?
Name of Person Convicted

First NameLast Name
List Specific Charge
Name of Court
Address of Court

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Convicted

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Has the prospective permit holder or anyone having at least a five percent (5%) ownership interest, managers or employees of the business been convicted within the past five (5) years of any two (2) or more misdemeanors involving misuse or abuse of alcohol or the illegal use of drugs, including, but not limited to, driving under the influence or while impaired, public intoxication, as defined in TCA § 39-17-310, et seq., disorderly conduct when it involves the use of alcohol or the illegal use of drugs, and/or any violation of the laws against possession, sale, manufacture for sale, or transportation of beer or other alcoholic beverages, or the manufacture, delivery, sale, or possession with intent to manufacture, deliver, or sell any controlled substance that is listed in TCA Title 39, Chapter 17, Part 2, schedules I through V, et seq., and/or any crime involving moral turpitude?
Name of Person Convicted

First NameLast Name
List Specific Charge
Name of Court
Address of Court

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Convicted

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Has the prospective permit holder or anyone having at least a five percent (5%) ownership interest had a beer permit revoked, suspended or denied in the State of Tennessee?
Date Permit Was Revoked, Suspended, or Denied

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name of Business
Address of Business

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reason for Revocation
Is this application for a new location?
Name of Previous Permit Holder

First NameLast Name
Mailing Address of Previous Permit Holder

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does applicant have any type of personal, family, or business relationship or connection to the individual, business, or corporation that previously or currently possesses a permit for this location?
Explain relationship or connection to the individual, business, or corporation that previously or currently possesses a permit for this location.
Does this business currently possess or will it apply for any license from the Tennessee ABC?
Type of License Business Currently Possesses
Type of License Business Will Apply For
Manager Information
Name and Address of Manager1

First NameLast Name
Driver's License Number
State That Issued Driver's License
Social Security Number
Address for Manager1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number for Manager1
Please enter a valid phone number.Format: (000) 000-0000.
Name and Address of Manager2

First NameLast Name
Driver's License Number
State That Issued Driver's License
Social Security Number
Address for Manager2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number for Manager2
Please enter a valid phone number.Format: (000) 000-0000.
Use of Permit
Will the permit be used to operate two or more restaurants or other businesses under the same permit as permitted in TCA 57-5-103(a)(4) within the same building?
Name of Business
Primary Use of Business
Employee Training Policy
Does your company have a training policy for employees regarding the sale of beers to minors?
Describe your company's training policy
If your company does NOT have a training policy, do you plan to implement a training policy in the future?
Responsible Vendor Program
Is this business certified under the Tennessee Alcoholic Beverage Commission's Responsible Vendor Program?
Has this business or any employee ever had a Responsible Vendor Certificate revoked, suspended, or canceled by the Tennessee Alcoholic Beverage Commission?
By my signature, I hereby certify that I understand and agree to comply with all applicable laws, statutes, codes and rules if granted a permit and am aware of the following:

1. The applicant must hold a valid City of Dickson business license to obtain a beer permit. This permit shall be displayed in a prominent place in the establishment.

2. The applicant is required to provide documentation of the Tennessee Department of Revenue certificate of sales tax registration or proof of application for such to the City.

3. A non-refundable $250 application fee must accompany this application payable to the City of Dickson.

4. A privilege tax of $100 is imposed on the business effective January 1 and each successive January 1 payable to the City of Dickson. In the case of a new permit, the permit holder shall pay the tax on a prorated basis for each month remaining until the next tax payment date.

5. No person, firm, corporation, joint-stock company, syndicate, or association having at least a five percent (5%) ownership interest in the applicant has been convicted of any violation of the laws specified in this application within the past ten (10) years.

6. No beer will be sold except at places where such sale will not cause congestion of traffic or interference with schools, churches, or places of public gathering, or otherwise interfere with public health, safety and morals.

7. All sales will conform to the class of permit issued. Any desire to change the class of permit will require a new application.

8. No sale shall be made to minors. Permit holder accepts responsibility for any prohibited sales made by employees.

9. A permit holder shall be required to amend or supplement its application promptly if a change in circumstances affects the responses provided in its application.

10. The permit holder must return the permit to the City of Dickson within fifteen (15) days of termination of the business, change in ownership, relocation of the business or change of the business’s name; provided, that notwithstanding the failure to return a beer permit, the permit shall expire on termination of the business, change of ownership, relocation of the business or change in the business’s name.

11. The beer board shall have the power to revoke or suspend a beer permit when the holder thereof is guilty of making a false statement or misrepresentation in the application, for failure to pay the privilege tax in a timely manner or for any violation of law, statute or ordinance following a hearing.

12. Where a permit has been refused, the applicant shall not be allowed to apply again for a permit on the same premises until after the expiration of a twelve (12) month period.

13. I have read and am familiar with the provisions of Title 8 Chapter 2 of the City of Dickson Municipal Code entitled "Beer.”
City of Dickson Municipal Code - Title 8 Chapter 2 - Beer
I, the applicant, have read and understand the Dickson Municipal Code - Title 8 - Chapter 2 - Beer
The signing of this application acknowledges that I am aware of the laws prohibiting the sale of beer to minors and that I will comply with all provisions and restrictions as outlined.
APPLICATION MUST BE SIGNED IN FRONT OF A NOTARY PUBLIC
Beer Permit Signing Options

1. You can PRINT the application, take the application to a notary, and sign application in front of the notary. Once the application is notorized bring the application to City Recorder Kimberly Givens at City Hall located 600 East Walnut Street Dickson, TN 37055

2. You can SUBMIT the application. Your unsigned application will go to City Recorder Kimberly Givens. Kimberly will print your application. You can come by City Hall to sign it and have it notorized. Your application is not complete until it has been signed.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature of Applicant (Must Be Signed In Front of A Notary Public)
TENNESSEE NOTARY ACKNOWLEDGMENT

State of Tennessee County of ________________________

On this ________________________________, before me personally appeared

______________________________________, to me known to be the person(s)

described in and who executed the foregoing instrument, and acknowledged that

such person(s) executed the same as such person’s free act and deed.

WITNESS my hand and seal, at office in _______________________________,

Tennessee this ___________________________, __________.

____________________________________

Signature of Notary Public

Commission Expires: _____________

(Seal)
Background Check Information and Instructions
Tennessee Bureau of Investigation (TBI) Background Check

Instructions for Fingerprinting - Tennessee Applicant Processing Services
Should be Empty:

City of Dickson, Tennessee

Applicant Information

Business Information

Annual Privilege Tax Contact Information

Business Ownership

Owners Background Information

Manager Information

Use of Permit

Employee Training Policy

Responsible Vendor Program

Tennessee Bureau of Investigation (TBI) Background Check