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IL 567-0050 (1/2019)
APPLICATION FOR STATE OF ILLINOIS
SPECIAL USE PERMIT LIQUOR LICENSE
Add a $25.00 late fee to EACH application if you expect that the application
will not be received at the Commission office at least 14 days PRIOR to
the scheduled event start date. The Commission requires this lead time
in order to schedule site inspections.
LATE FEE:
ADD $25.00
Fee is per event location. Event duration CANNOT exceed 15 days per
application, and the application must be received at the Commission
offices AT LEAST 14 days prior to the start of the event.
NOTE: Currently there is no limit on the number of days that an event
can take place at a specific location, but it is important to note that 15
days is the maximum allowed per application. If your event exceeds 15
days, additional applications and fees must be submitted.
FEE: $150.00
(1 day only)
FEE: $250.00
(2-15 days)
Local liquor licensing authority
approval is required for this license.
Dram shop insurance to the maximum
limit is required for this license.
On the following pages, please PRINT OR TYPE the information requested in the spaces provided. The form
must bear an original signature; no faxed or photocopied forms or rubber stamped signatures will be accepted.
IMPORTANT NOTICE: THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT
(235 ILCS 5/1 ET SEQ.). DISCLOSURE OF THIS INFORMATION IS MANDATORY. FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE.
Illinois Liquor Control
Commission
JB Pritzker
Governor
50 W. WASHINGTON ST., SUITE 209
CHICAGO, ILLINOIS 60602
TELEPHONE: 312 814-2206
[email protected]
300 W. JEFFERSON ST., SUITE 300
SPRINGFIELD, ILLINOIS 62702
TELEPHONE: 217 782-2136
WEBSITE: ILCC.lllinois.gov
The Illinois Liquor Control Commission is encouraging all special use applicants to apply online via MyTax Illinois. To
avoid the $25 fee for late applications, we strongly recommend submitting your application 14 days in advance. Once
you have received local approval for your special event and your certificate of insurance for your upcoming special event,
you then need to log into your MyTax Illinois account at mytax.illinois.gov. You can find the step-by-step instructions on
our website www2.illinois.gov/ilcc.
If you have questions about the application process, or if you have trouble submitting your application, please contact
[email protected] or you can call the ILCC office at (312) 814-2206 or (217) 782-2136 for additional assistance.
DEFINITION: The Special Use Permit Liquor License shall allow an Illinois licensed liquor retailer to transfer a portion of
its alcoholic liquor inventory from its licensed retail premises to a designated site for a special event. Note: a Special
Use Permit Liquor License must be obtained for EACH location and cannot exceed 15 days in duration.
ELIGIBILITY:
APPLICANT MUST ALREADY HOLD A STATE OF ILLINOIS RETAIL LIQUOR LICENSE.
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Provide the information requested in the spaces below, including your current State of Illinois Retail Liquor License
number, the corporate/organization name, the corporate/organization Federal Employer Identification Number (FEIN);
your Illinois Department of Revenue Sales Tax Account ID; telephone number, and your corporate/organization mailing
address and county.
FOR OFFICIAL USE ONLY
DATE ISSUED
LICENSE NO.
EXPIRATION DATE
FOR OFFICE
USE ONLY
COUNTER
Write your “Doing Business As” (DBA) name, telephone number, address and county.
1. APPLICANT INFORMATION
Check this box if license and ILCC correspondence should be sent to this address.
Application for State of Illinois Special Use Permit Liquor License
( )
AREA CODE/TELEPHONE NO.
NAME/DOING BUSINESS AS (DBA )
ADDRESS
CITY
S TATE
ZIP CODE
COUNTY
2a.
BUSINESS PREMISE INFORMATION
Check this box if license and ILCC correspondence should be sent to this address.
STATE LIQUOR LICENSE NO.
NAME
( )
FEDERAL EMPLOYER ID NO.
ILLINOIS SALES TAX ACCOUNT ID
AREA CODE/TELEPHONE NO.
ADDRESS
CITY
S TATE
ZIP CODE
COUNTY
IL 567-0050 (1/2019)
2b.
CONTACT PERSON’S NAME (First, Last)
BUSINESS PHONE NUMBER
( )
ALTERNATE PHONE NUMBER (Home, Cell, etc.)
CONTACT INFORMATION
Provide the requested contact information for your business. The contact person should be the responsible party we can contact 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.
EMAIL ADDRESS
FAX NUMBER
( )
( )
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IL 567-0050 (1/2019)
3. EVENT DETAIL
4.
CORPORATE/ORGANIZATION OFFICER INFORMATION
Provide the date(s) and time(s) that the event will be held. When you receive your printed license certificate from the
Commission, times will be listed in military time (e.g., “0200” = 2AM, “1200” = noon”, “2400” = midnight).
Provide the address/location of the event. If an address is not available, provide specific instructions to enable
our investigators to find the event. Note: Only one location is allowed per application.
Provide the name/type of the event (e.g., neighborhood festival, Octoberfest, fish fry, tasting/sampling, etc.).
Determine the total number of event themes/types for which approval is requested. Use a separate application for
each event theme/type.
Determine the total number of days and locations covered by the event. For example, if your event is held on three
successive Fridays at the same location, you are only required to fill out a single application and pay a single
application fee since the total duration is 15 days or less and the location is the same. If the location changes
weekly in the aforementioned example, however, you will be required to fill out three applications and pay three
fees.
•
•
•
•
•
DATE OF EVENT:
EVENT STARTS
(MONTH/DAY/YR)
DATE OF EVENT:
EVENT ENDS
(MONTH/DAY/YR)
EVENT TIME:
TIME FROM
( AM/PM )
EVENT TIME:
TIME TO
( AM/PM )
LOCATION OF EVENT:
STREET ADDRESS
CITY/STATE/ZIP
EVENT THEME:
TYPE OF EVENT
( )
NAME (LAST, FIRST, MIDDLE INITIAL)
HOME ADDRESS
CITY
S TATE
ZIP
SOCIAL SECURITY NO.
DATE OF BIRTH
SEX TITLE/POSITION AREA CODE/TELEPHONE NO.
% OWNED
( )
NAME (LAST, FIRST, MIDDLE INITIAL)
HOME ADDRESS
CITY
S TATE
ZIP
SOCIAL SECURITY NO.
DATE OF BIRTH
SEX TITLE/POSITION
AREA CODE/TELEPHONE NO.
% OWNED
( )
NAME (LAST, FIRST, MIDDLE INITIAL)
HOME ADDRESS
CITY
S TATE
ZIP
SOCIAL SECURITY NO.
DATE OF BIRTH
SEX TITLE/POSITION
AREA CODE/TELEPHONE NO.
% OWNED
The individual signing this application at the bottom of Page 4 MUST be listed in this section.
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SIGNATURE OF APPLICANT/AUTHORIZED AGENT
IL 567-0050 (1/2019)
TITLE/POSITION
DATE
Determine the payment amount for your application(s). For efficiency, you may group multiple applications and submit a
single check to cover all events. Make check or money order payable to: ILLINOIS LIQUOR CONTROL COMMISSION.
The Commission does not accept U.S. currency/cash as payment.
8.
PAYMENT
If you expect that your application will not arrive at the Commission office within the required 14-day advance notice, submit
an additional $25.00 late fee for EACH application. If the late fee is not included, the application(s) will be rejected.
9.
LATE FILING FEE
The application must be signed and dated by the applicant or an authorized agent of the applicant along with the title/position of the person signing.
The signature must be an original; rubber stamps, photocopies, or faxed copies are not accepted.
5.
PRIOR LIQUOR LICENSE INFORMATION
10.
SIGNATURE/DATE/TITLE
You MUST submit proof that Dram Shop insurance to the maximum limit has been secured for this event.
Attach a photocopy of the insurance rider to this application. Remember, it must cover the location where the special
event is being held and the coverage must coincide with the dates of the event.
ATTACH:
DRAM SHOP INSURANCE RIDER
(IF MISSING, APPLICATION WILL BE REJECTED)
7.
DRAM SHOP INSURANCE
Local Liquor
Commissioner’s
Event Approval
Stamp Here
( if applicable )
You MUST submit proof of local authority approval for your event. Generally, your local municipality will issue
approval in the form of a letter, a certificate, or a rubber stamp. If the event is taking place in an unincorporated area,
the county will need to provide the approval. If the event is taking place on state or federal property, please contact our
office as special approval will be necessary. Local authorities will use the box below for “approval” stamps or seals,
such as the City of Chicago Liquor Commission. If stamps/seals are not applicable, attach a photocopy of the approval
letter or certificate.
ATTACH:
LOCAL AUTHORITY APPROVAL
(IF MISSING, APPLICATION WILL BE REJECTED)
6. LOCAL AUTHORITY APPROVAL
or
A.
B.
If “yes,” provide a complete written explanation of the circumstances on a separate sheet of paper.
Has the organization had any previous liquor license suspended or revoked?
Yes
No
Has the organization ever applied for and been denied a liquor license?
Yes
No
If “yes,” provide a complete written explanation of the circumstances on a separate sheet of paper.
I, THE UNDERSIGNED APPLICANT OR AUTHORIZED AGENT THEREOF, SWEAR OR AFFIRM THAT: THE MATTERS STATED IN THE FORE-
GOING 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 REGULA-
TIONS, 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.
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