HomeMy WebLinkAboutalc app 3Department of Alcoholic Beverage Control State of California
APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S)
ABC 21 t (6/49)
TO: Department of Alcoholic Beverage Control File Nutnber: 521269
1900 CHURN CREEK RD Receipt Number: 2108735
STE 215 Geographical Code: 0400
BEDDING, CA 96002 Copies Mailed Date: Apri12S, 2012
(530} 224-4$30 Issued Date:
DISTRICT SERVING LOCATION: BEDDING ~~
First Owner: HALE, JIMMIE EDWARD i'u ~ 3 ~ ~~
Name of Business: JIMS AMERICAN GRILL ~~~A
Location of Business: 13915 S PARK DR
MAGALIA, CA 95954
County: BUTTE
Is Premise inside city limits? No Census Tract 001.7.02
Mailing Address: 5585 DESANTE LN
(If different from PARADISE, CA 95969-6003
prerrlises address)
Type of license(s): 41
Transferor's licenselname: Dropping Partner: Yes No
License Tybe Transaction Ty Be Fee Tune Master Dup Date Fee
41 - On-sale Beer And Wine ANNUAL FEE NA Y fl 04/25/12 $350A0
4l - On-Sale Beer And Wine O1tIGINAI, FEES NA Y 0 04/25/12 $300.00
NA FEDERAL FINCrERPRINTS NA N 2 04/25/12 $48.00
NA STATE FINGERPRI NT5 NA N 2 44/25//2 $78.00
Total $776.00
Have you ever been convicted of a felony? Na
Have you ever violated any provisions of the Alcoholic Beverage Control Act, or regulations of the
Department pertaining to the Act? No
Explain any "Yes" answer to the above questions on an attachment which shall be deemed part of this application,
Applicant agrees (a}that any tnanager err-ployed in an on-sale licensed premises will have a!I the qualifications of
a licensee, and (b) that he will not violate or cause or permit to be violated at~ry of the provisions of the Alcoholic
Beverage Control Act.
STATE OF CALIFORNIA County of BUTTE Date: April 25, 2012
Undcr penalty of perjury, each person whose signature appears below, certifies and says: {E) He is an applicant, or one of the applicants, or an executive officer
of tl~e applicant corporation, named in the Coregoing application, duly authorized to make this application on its behalf; (2) that he has read the foregoing and
knows the contents thereof and that each of the above stateme~us therein made are tn~e; (3) that no person other than the applicant or applicants has any direct
or indirect interest in the applicant or applicant's business to be conducted under the license(s) for which this application is made; (4} that the transfer
application or proposed transfer is not made to satisfy the payment of a loan or to fttlfill an agreement entered into more than ninety (9D) days preceding the day
on which the transfer application is filed with the Department or to gain ar establish a preference to ar for any creditor or transferor or Eo defraud or. injure any
creditor of transferor; {5} chat the transfer application may b i[hdrawn by either the applic nt or the licensee with no resulting liability to the Department.
Applicant Name(s) ~ ~~~~~.= Applicant Signature{s}
HALE, JIMMIE EDWARD
C~ ' ~~ ~