DEFINITION: A Retailer’s Liquor License shall allow the licensee to sell and offer for sale at retail, only at the premises specified in such
license, alcoholic liquor for use or consumption, but not for resale in any form; provided that any retail liquor license issued to a manufacturer
shall only permit such manufacturer to sell alcoholic beverages at retail on the premises actually occupied by such manufacturer [235ILCS
5/5-1(d)], the only exception being a wine-maker’s retail license—2nd location [235 ILCS 5/5-1(i)]. All applicants for licensing as a liquor
retailer must complete this application. Respond to all questions on the application and furnish all required supporting documents. Failure
to do so will result in the rejection of the application and non-issuance of a state liquor license.
1) Photocopy of current Local Liquor License (contact your Local Liquor Commission)
2) Photocopy of Certificate of Insurance (not the Policy Declaration) if alcohol will be consumed on the premise;
3) Proof of Purchase (e.g., bill of sale, closing statement, lease, recorded deed) IMPORTANT: You must present
proof that the applicant (e.g., corporation, LLC, partnership, or sole proprietor) has the right to possession of the
property. If there is an existing state liquor license on the premises, you will need to provide a copy of the bill of
sale for the business and any inventory (Brand Name, Bottle Size & Quantity) purchased.
Note: The closing on the purchase of the business must occur prior to applying for your state license
4) Check or Money Order payable to: ILLINOIS LIQUOR CONTROL COMMISSION (ILCC).
Processing time for a Retailer Liquor License is approximately 3 - 10 business days
NOTE: The date of expiration of your initial Illinois license will coincide with the 12-month period that begins on the issue date of your local
liquor license. In some cases, the term of your rst year’s Illinois liquor license may be less than a full year in duration.
IL 567-0015 (1/2019)
PAGE 1 OF 7
APPLICATION FOR STATE OF ILLINOIS
RETAILER’S LIQUOR LICENSE
RETAILER’S LIQUOR LICENSE
FEE: $750.00
REMEMBER: YOU CANNOT PURCHASE OR SELL ALCOHOL
WITHOUT A VALID STATE LIQUOR LICENSE
Illinois Liquor Control
Commission
JB Pritzker
Governor
50 W. WASHINGTON ST., SUITE 209
CHICAGO, ILLINOIS 60601
TELEPHONE: 312 814-2206
[email protected]
300 W. JEFFERSON ST., SUITE 300
SPRINGFIELD, ILLINOIS 62702
TELEPHONE: 217 782-2136
WEBSITE: ILCC.lllinois.gov
Options for submission:
• Online via MyTax account - Instructions: https://ilcc.illinois.gov/content/dam/soi/en/web/ilcc/siteassets/pages/home/Retailers.pdf
• In person - By Appointment: https://outlook.office365.com/owa/calendar/[email protected]/bookings/
• By Mail - Mail to either the Chicago or Springfield Address
The following documents and information are REQUIRED prior to receiving for your state license:
Use your mouse or Tab key to move through the fields. Use your mouse or space bar to enable check boxes.
IL 567-0015 (1/2019)
PAGE 2 OF 7
NAME
C.
NAME
Enter the name of the sole proprietorship, partnership, corporation (Illinois, national, or foreign), or limited liability company in this box.
Note: This name must be consistent with the name printed on your local liquor license and on your Illinois Department of Revenue Sales
Tax Registration Certicate.
Enter the eight-digit Illinois Department of Revenue Sales Tax Account ID. YOU
MUST HAVE THIS NUMBER IN ORDER FOR A LICENSE TO BE ISSUED.
If you need to obtain this number, visit tax.illinois.gov, click on “Businesses”
and then “How do I Register” under the Business Registration section. If you
have any questions, call 217 785-3707.
B.
ILLINOIS SALES TAX ACCOUNT ID
ILLINOIS SALES TAX ACCOUNT ID
Enter your Federal Employer Identication Number (FEIN) in this box. The
FEIN is a nine-digit number issued by the Internal Revenue Service. This
number is used for verication purposes only. If you do not have a FEIN,
call 1 800 829-3676 for general information on how to apply for and obtain
the forms you need.
A.
FEIN
MAILING ADDRESS/PHONE (if different than physical location address/phone)
D.
FEIN #
Enter the mailing address if different than physical location addres. Include: street address, county, city, state, ZIP code, telephone number
(with area code and extension, if applicable) of the sole proprietorship, corporation, etc.
COUNTY
CITY
STATE
ZIP CODE
STREET ADDRESS
AREA CODE/TELEPHONE NO.
( )
EXT.
Application for State of Illinois Retailer’s Liquor License
APPLICANT - CORPORATE INFORMATION
1.
EXPIRATION DATE
DATE ISSUED
LICENSE NO.
If you want your renewal application, your license certicate and
other ILCC correspondence sent to your corporate
address, please check this box.
Do you currently hold ve or less retail liquor licenses in another state(s)? If yes, please provide the following information for each out-of-state retail liquor license.
E.
CURRENT RETAIL LIQUOR LICENSES IN OTHER STATES
BUSINESS NAME CITY STATE
BUSINESS NAME CITY STATE
BUSINESS NAME CITY STATE
BUSINESS NAME CITY STATE
BUSINESS NAME CITY STATE
2.
STATUS OF BUSINESS
Check the applicable box (sole proprietorship, partnership, Illinois corporation, foreign corporation, or limited liability company) which
corresponds to your business’ official papers filed with the Office of the Illinois Secretary of State.
Based on the box that you check, provide: the date of the filing of the sole proprietorship with the county clerk; in the case of a partnership,
the date of formation of the partnership; in the case of an Illinois corporation, the date of its incorporation; in the case of a foreign corporation,
the foreign state where it was incorporated and the date, as well as the date of its becoming qualified under the “Business Corporation Act
of 1983” to transact business in the State of Illinois; or in the case of a limited liability company, the date of formation of such entity.
Note:
In the case of a sole proprietorship, Section 5/6-2 of the Illinois Liquor Control Act requires that the
business owner reside within the jurisdiction that grants the local liquor license. Drivers License copy required.
A.
C.
D.
E.
B.
Sole Proprietorship
Partnership
Illinois Corporation
Foreign Corporation
Limited Liability Company
3.
OWNERSHIP INFORMATION
Provide the owner/ofcer/partner information in accordance with the business status described under Question 2. This information must be
submitted for all owners/ofcers/partners. The same information must be submitted for shareholders with interests equal to or exceeding
ve percent.
The following information must be provided for each individual applicant, sole proprietor, partner, corporate ofcer or director (whether or
not they own any stock), shareholder owning in the aggregate stock equal to or more than ve percent (including ofcers, directors and
shareholders with stock equal to or more than ve percent for all corporate shareholders), and/or manager or agent conducting the business.
Indicate the total percentage of stock of the corporation, if any, which is held by persons who hold less than a ve percent interest. All not-
for-prot organizations and associations must provide the requested information for all corporate ofcers, directors and managers.
If additional space is needed, provide information on a separate sheet(s) in the same format as this application. BEFORE COMPLETING
THIS SECTION, CHECK QUESTION NO. 7 - ELIGIBILITY.
For each owner/ofcer/partner/ve percent shareholder, provide full name, home address, city, state, ZIP Code, Social Security number, date
of birth, sex, title/position, home telephone number, and percentage ownership. Total percentage ownership should equal 100 percent. If
there are a number of shareholders owning less than ve percent, indicate the aggregate total of ownership under Line E.
%
E.
Total percentage of all stock held by all persons with less than five percent interest.
IL 567-0015 (1/2019)
PAGE 3 OF 7
Date led with County Clerk:
Date of Formation:
Date of Incorporation:
State of Incorporation:
IL Secretary of State File #:
G.
H.
I.
F.
Not-For-Prot
Government
Receivership
Trust/Estate
Date Qualied to do Business in IL:
A.
B.
C.
D.
( )
NAME (LAST, FIRST, MIDDLE INITIAL)
HOME ADDRESS
CITY
STATE
ZIP
SOCIAL SECURITY NO.
DATE OF BIRTH
SEX TITLE/POSITION AREA CODE/HOME TELEPHONE NO.
% OWNED
( )
NAME (LAST, FIRST, MIDDLE INITIAL)
HOME ADDRESS
CITY
STATE
ZIP
SOCIAL SECURITY NO.
DATE OF BIRTH
SEX TITLE/POSITION
% OWNED
( )
NAME (LAST, FIRST, MIDDLE INITIAL)
HOME ADDRESS
CITY
STATE
ZIP
SOCIAL SECURITY NO.
DATE OF BIRTH
SEX TITLE/POSITION
% OWNED
( )
NAME (LAST, FIRST, MIDDLE INITIAL)
HOME ADDRESS
CITY
STATE
ZIP
SOCIAL SECURITY NO.
DATE OF BIRTH
SEX TITLE/POSITION
% OWNED
AREA CODE/HOME TELEPHONE NO.
AREA CODE/HOME TELEPHONE NO.
AREA CODE/HOME TELEPHONE NO.
4.
BUSINESS LOCATION INFORMATION
If you want your renewal application, your license certicate and other ILCC correspondence sent to your business location
address, please check this box.
PAGE 4 OF 7
IL 567-0015 (1/2019)
AREA CODE/TELEPHONE NO.
( )
EXT.
B.
TELEPHONE
Enter the area code, telephone number and extension at the business
location.
A.
NAME/DOING BUSINESS AS (DBA)
Enter the name of the business which will be selling or serving alcoholic beverages at the licensed premises. Note: This name must be consistent
with the name printed on your local liquor license and on your Illinois Department of Revenue Sales Tax Registration Certicate.
NAME/DOING BUSINESS AS (DBA )
E.
WAREHOUSING
If any of your inventory is warehoused, provide the street address, city, state, ZIP code and county of the warehouse.
ADDRESS
CITY
STATE
ZIP CODE
COUNTY
F.
RIGHTS TO THE PROPERTY
LANDLORD NAME
AREA CODE/PHONE NUMBER (Home, cell, etc.)
( )
EMAIL ADDRESS
D.
BUSINESS TYPE
Check the one box which best describes the type of business. If the selections listed are inappropriate, describe the business under “other”.
CONVENIENCE & GAS
SMALL GROCERY
GAS STATION
OTHER
A.
B.
C.
D.
DRUG STORE/PHARMACY
RESTAURANT
CONVENIENCE
SUPERMARKET
E.
F.
G.
H.
LIQUOR STORE
DEPARTMENT STORE
BAR/TAVERN
HOTEL/MOTEL
I.
J.
K.
L.
C.
ADDRESS
Enter the address, city, state, ZIP Code and county of the business location. This address must be consistent with information on your local liquor
license and on your Illinois Department of Revenue Sales Tax Registration Certicate.
Remember, you MUST close on the business purchase prior to applying for your state license. Proof of business purchase is required (e.g.,
bill of sale, closing statement). IMPORTANT: You must present proof that the applicant (e.g., corporation, LLC, partnership, or sole proprietorship)
has the right to possession of the property (e.g., deed or lease). If there is an existing state liquor license on the premises, this license should be
surrendered (if available). The applicant also needs to provide the State of Illinois Liquor Commission with a Bulk Sales Release Order (Address
Release) if applicable. For more information, contact the Illinois Department of Revenue at [email protected].
ADDRESS
CITY
STATE
ZIP CODE
COUNTY
FAX NUMBER
( )
I hereby certify that the property is owned by the applicant
I hereby certify that the property is leased from the landlord
I hereby certify that the property is managed via an operating or managment agreement
ADDRESS
CITY
STATE
ZIP CODE
COUNTY
5. LOCAL LICENSE INFORMATION/LIQUOR LICENSE HISTORY
C.
TYPE OF LIQUOR LICENSE
Check the box which describes the manner in which you sell alcoholic beverages to consumers. This information must be consistent with your approval
granted by the local liquor licensing authority.
ON-PREMISES CONSUMPTION (patrons consume alcoholic beverages on the premises only)
OFF-PREMISES CONSUMPTION (carry-out purchases only)
ON/OFF-PREMISES CONSUMPTION COMBINATION (both on the premises consumption and carry-outs)
YOU MUST PROVIDE A PHOTOCOPY OF YOUR LOCAL LIQUOR LICENSE
IL 567-0015 (1/2019)
PAGE 5 OF 7
A.
LOCAL LIQUOR LICENSE INFORMATION
Please enter the local liquor license number, the date it was issued, the date it expires, the municipality or county that issued the license and the date
you intend to begin selling alcoholic beverages at this business location. Alcoholic beverages may not be sold or offered for sale prior to the date that
the state liquor license is issued. If you began selling alcoholic beverage products before obtaining this license, you are required to ll out a deliquency
afdavit to explain the circumstances. Note: In unincorporated areas, the county acts as the local liquor licensing authority.
MUNICIPALITY/COUNTY ISSUING LOCAL LIQUOR LICENSE
LOCAL LICENSE NO.
DATE ISSUED
EXPIRATION DATE
DATE YOU BEGAN LIQUOR SALES AT THIS LOCATION
Indicate by checking the correct box whether or not this is the applicant’s rst application for a state liquor license at any location. If you check “no”,
indicate the date of your rst state liquor license application; whether the license was granted, denied or withdrawn; and the address of your rst state
liquor license application. If you have ever had a license application denied, or if you ever withdrew an application, please provide a written statement
describing the reason and circumstances.
IS THIS YOUR FIRST STATE LICENSE APPLICATION?
IF NO, PROVIDE DATE FIRST APPLIED:
DISPOSITION:
GRANTED
DENIED
WITHDRAWN
ADDRESS OF FIRST STATE APPLICATION:
B.
FIRST LICENSE APPLICATION - LICENSE HISTORY
YES
NO
Your local license must contain the expiration date, issue date, and license number.
D.
AUTHORIZED HOURS
These hours must be the hours authorized by the local municipality (or county if in an unincorporated area):
MON
TUES
WED
THUR
FRI
SAT SUN
E.
AVAILABLE HOURS
These hours indicate when a representative is available for an inspection of the premises:
MON
TUES
WED
THUR
FRI
SAT SUN
WHAT IS THE FIRST DAY YOU EXPECT TO BE OPEN AND SELLING ALCOHOL?
F.
EXPECTED OPENING DATE
7. ELIGIBILITY QUESTIONS
The questions below pertain to the applicant and any other person listed under “Corporate Ofcer/Ownership Information” listed on page 3 of this
form. IF ANY QUESTIONS ARE ANSWERED WITH A “YES” ATTACH A FULL WRITTEN EXPLANATION TO THIS DOCUMENT.
8.
VIDEO GAMING
Are you delinquent in the payment of any Illinois business taxes (sales, withholding, etc.)? [235 ILCS 5/6-3]
YES
NO
7A
Are you delinquent under the cash beer law?
If a retailer, are you delinquent under the 30-day credit law?
Have you ever submitted an application for a liquor license which has been denied? [235 ILCS 5/6-2(14)]
Have you ever had any previous liquor license suspended or revoked? [235 ILCS 5/6-2(7)]
Have you ever been convicted of a felony? [235 ILCS 5/6-2(4)]
Have you ever been convicted of a gambling offense as dened under Section 6-2 of the Illinois Liquor Control Act
which, includes offenses enumerated in 720 ILCS 5/28-1(a)11, gambling; 720 ILCS 5/28-1.1(a)-(d) syndicated gambling;
and 720 ILCS 5/28-3 keeping a gambling place?
Do you possess a current Federal Wagering Stamp?
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
7B
7C
7D
7E
7F
7G
7H
YES
NO
Have you received or borrowed money or anything of value directly or indirectly from any other licensees, representatives
of a licensee, or suppliers of alcoholic products?
YES
NO
7J
Are you, or is any other person having a direct interest in your place of business, a public or law enforcing ofcial with
jurisdictional authority? [235 ILCS 5/6-2(14)]
YES
NO
7I
Are you or any other person having a direct interest in your place of business more than 30 days delinquent complying
with a child support payment order? [5 ILCS 100/10-65(c)]
YES
NO
7K
Are you in violation of the required liquor liability insurance coverage stated in Section 6-21(a) of the Illinois Liquor
Control Act [235 ILCS 5/] regarding establishments that sell alcoholic liquors for use or consumption on the licensed
retail premises?
YES
NO
7L
If a corporate licensee, is your corporation ineligible to be issued this license?
[235 ILCS 5/6-2(a)(10) and 5/6-2(a)(10a)]
YES
NO
7M
Do you possess a current Illinois Video Gaming License? If YES, please provide the information below:
YES
NO
VIDEO GAMING LICENSE NUMBER:
Have you made an application for an Illinois Video Gaming License that is currently pending? If YES, please provide
information below:
YES
NO
VIDEO GAMING NUMBER APPLICATION NUMBER: DATE APPLIED:
6. CERTIFICATE OF INSURANCE
You MUST provide a copy of your Certicate of Insurance if alcohol is consumed on the premises (this certicate is not required for
carry-out only establishments). The Certicate of Insurance must show that you have liquor liability insurance and must include the
following: 1) the applicant named as the insured (e.g., if the applicant is a corporation, then the corporation’s name must be listed;
if the applicant is a sole proprietor, then the sole proprietor’s name must be listed); 2) the address of the location where the liquor is
being consumed; and 3) the dates of coverage and the coverage limits.
ATTACH A PHOTOCOPY OF YOUR CERTIFICATE OF INSURANCE (not the Policy Declaration)
IL 567-0015 (1/2019)
PAGE 6 OF 7
10.
SIGNATURE/TITLE/DATE
Please sign and date the application form and provide your title with the organization. The application must be signed by an owner,
an ofcer, or partner. The signature must be original. Rubber stamps, photocopies, or faxed copies are not accepted.
I, THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF, SWEAR OR AFFIRM THAT: THE MATTERS STATED
IN THE FOREGOING APPLICATION ARE TRUE AND CORRECT; THEY ARE MADE UPON MY PERSONAL KNOWLEDGE AND
INFORMATION; THEY ARE MADE FOR THE PURPOSE OF REQUESTING THE STATE OF ILLINOIS TO ISSUE THE LICENSE
HEREIN APPLIED FOR; THE APPLICANT IS QUALIFIED AND ELIGIBLE TO OBTAIN THE LICENSE APPLIED FOR; AND THE
APPLICANT WILL NOT VIOLATE ANY OF THE LAWS OF THE UNITED STATES OF AMERICA OR THE STATE OF ILLINOIS, IN
PARTICULAR, THE ILLINOIS LIQUOR CONTROL ACT, RULES AND REGULATIONS, AND THE CIVIL RIGHTS SECTIONS THEREOF.
FURTHER, I AGREE TO NOTIFY THIS COMMISSION WITHIN 30 WORKING DAYS OF CHANGES IN ANY OF THE ABOVE
INFORMATION. (NOTE: IF THE PERSON SIGNING THIS APPLICATION IS NOT LISTED IN SECTION 3, THEY MUST PROVIDE
THE STATE WITH THEIR PERSONAL INFORMATION AS INDICATED IN SECTION 3 EVEN IF THEY DO NOT OWN FIVE PERCENT
OR MORE OF THE BUSINESS).
SIGNATURE OF APPLICANT
TITLE/POSITION
DATE
IL 567-0015 (1/2019)
PAGE 7 OF 7
9.
APPLICANT CONTACT INFORMATION
Provide the contact information for your business. The contact person should be the responsible party we can contact and who can answer
questions on behalf of the business. The mobile or alternate number should be in addition to any business numbers on le. The email address
should be the active email address for the business, not the personal email address of the contact person.
CONTACT PERSON’S NAME (First, Last)
BUSINESS PHONE NUMBER
( )
ALTERNATE PHONE NUMBER (Home, Cell, etc.)
EMAIL ADDRESS
FAX NUMBER
( )
( )
Reset
Print