Addendum for New Retail Alcohol License Applications

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As the local authority, the City of Davenport has the responsibility of approving all beer, wine, and liquor licenses for issuance by the State of Iowa Alcoholic Beverages Division. It takes approximately 45 days to process a beer, wine, or liquor license application from the time all required documents are received by the City of Davenport until the license certificate is issued by the State of Iowa. The licensee shall complete an Application Addendum annually.

* Denotes a required field

BUSINESS INFORMATION

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Business Phone Number*
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ZIP*
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Second portion of ZIP Code is optional.
Phone Number*
-- ext
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Phone Number*
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Has there been an active Retail Alcohol license at this premises within the past 6 months?*
Have you or will you be applying for a gambling license?*
Is the premises located within 600 feet of a state-registered child-development home, child-care center, elementary school, or secondary school?*
ADDITIONAL QUESTIONS FOR CLASS "E" RETAIL ALCOHOL LICENSES ONLY
Is the store of at least 1,000 square feet?*
Is the premises located within 1,320 feet of an active Class "E" Retail Alcohol license located in "Downtown Davenport"?*

FINANCIAL INFORMATION

NEW license applicants must provide a copy of a bank statement or balance sheet (not a profit/loss statement) for the business named above. Please email the document to liquor@davenportiowa.com.
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Are there sources of funding other than revenues generated by the business itself?*
 

OWNERSHIP INFORMATION

ALL persons holding any interest in the business must be listed below including owners, officers, or directors. Please indicate the percentage of ownership (even if 0%) for each person. Total ownership must equal 100%. If there are more than 3 owners, please email the owner's information to liquor@davenportiowa.com.
OWNER 1
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Date of Birth*
 , Date of Birth
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ZIP*
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Second portion of ZIP Code is optional.
Phone Number*
-- ext
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OWNER 2
 
 
 
 
Date of Birth 
 , Date of Birth
 
 
 
ZIP 
-
Second portion of ZIP Code is optional.
Phone Number 
-- ext
 
 
 
OWNER 3
 
 
 
Date of Birth 
 , Date of Birth
 
 
 
ZIP 
-
Second portion of ZIP Code is optional.
Phone Number 
-- ext
 
 
 
ADDITIONAL OWNERSHIP QUESTIONS
Has any person listed under "Ownership Information" for this license ever applied for a license to sell alcoholic beverages at any other location besides this application?*
 
Has any person listed under "Ownership Information" for this license ever been arrested or convicted of a felony?*
 
Has any person listed under "Owner Information" for this license ever been arrested or convicted of any alcohol, gambling, or moral charges?*
 

ELECTRONIC SIGNATURE

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By clicking "Submit", you are testifying that all information provided in this addendum is true and correct. False information could lead to a denial of the retail alcohol application.