APPLICATION FOR LICENSE TO SERVE FERMENTED MALT BEVERAGES AND INTOXICATING LIQUORS

Common Council Approval

Council Decision

Approved

Denied

Common Council Approval Date

Clerk Final Status Check

Copy of certificate/license from another municipality has been received

Yes

No

N/A

Application Status

License Printed and Sent

Sent Denial Notice

Clerks Area Initals

Police Department Review

It is recommended that:

License be granted

License be denied

Reason for denial

PD Signature

Date (PD Signature)

PD Final Status Check

PD Final Initals

Application Type *

Initial(first time applying to Kaukauna)

Provisional

Renewal

Temporary

Note: From the submission date, there is a 15 day waiting period before the license is issued assuming application is approved. Only use the Provisional License as an option if the council will not meet within the 15 day waiting period.

I certify that I am a citizen of the United States and have been a resident of the State of Wisconsin continuously since *

First Name *

First Name of Applicant

Middle Name

Last Name *

Previous Name if any

Email *

Phone *

Address *

Address

Address 1

Address 2

City

State

Zip

Gender *

Male

Female

Date of Birth *

Race

Drivers License Number *

Upload Photo of Driver's License *

Maximum file size: 268.44MB

Have you been convicted of any felony, misdemeanor, or ordinance violation (other than traffic violations)? *

Yes

No

If yes, give details

Are there currently any criminal charges pending against you? *

Yes

No

If yes, give details.

Have you ever had a Bartender’s license before. Either in Kaukauna or somewhere else? *

Yes

No

If yes, please list Place and City where you held a previous licence

Place of Employement (Serving/Selling Location) *

Upload current copy of Bartender License or a Wisconsin Responsible beverage server certificate that is not more than two (2) years expired. *

Maximum file size: 268.44MB

Signature *

Clear

Date *

License Information

Licence Year

Licences Type

Payment Acknowledgement

Amount to Pay

Read-Only Field. This is the amount you will need to pay. If you don't get transferred to the payment screen please call 920.766.6300

The only information you will need to enter is your credit card information once the payment screen appears *

I understand

Your information and payment amount will populate on the next screen after you click continue *

I understand

Only Click the below "Continue to Payment" button ONCE! Depending on your internet connection, it may take a moment before moving to the payment screen. *

I understand

Payment Section

Payment Received

Yes

No

Section

Date