2. License Information:
4. Application Type
   -- Select One --Select OneRenewalNew License ApplicationTransferRelocation
5. License Type
   -- Select One --Select OneA-Nationally Organized Fraternal Order or Club - $3,528.00A2-Nationally Organized Fraternal Order or Club - $403.00B-Airport Terminal Building - $630.00C-Hotel or Motel Full Service - $3,654.00C2-Hotel or Motel - $945.00D-Sale at Retail of Alcoholic Beverages - $3,906.00E-Sale at Retail of Beer Only - $756.00F1-Restaurant - Alcoholic Beverages - 55/45 Split - $3,402.00F2-Restaurant - Beer/Wine Only - 55/45 Split - $1,449.00F3-Restaurant - Beer Only - 55/45 Split - $819.00G-Concession Bismarck Municipal Country Club - $693.00H-Commercial vessels on the Missouri River - $680.00I1-Restaurant - Alcoholic Beverages - 70/30 Split - $3,276.00I2-Restaurant - Beer and Wine Only - 70/30 Split - $1,386.00I3-Restaurant - Beer Only - 70/30 Split - $756.00J-Non-profit Organization Club or Establishment - $63.00K-Beer and Wine at the Bismarck Event Center - $630.00L-Beer & Wine at Parks & Recreation Locations - $334.00M-Catered Retail Beer, Wine, & Liquor - $630.00N-Domestic Winery - $756.00O-Microbrewery - $756.00P-Event Site - $630.00Q-Restaurant On-Sale and Off-Sale Wine - $3,600.00R-Commercial Airline - $50.00S-Beer Arcade - $800.00T-Senior Living Community - $334.00

   Please select the type of license you are applying for.
7. NOTE: This application must be accompanied by required fees.
   The $200 application fee is due when the application is submitted. (Fee does not apply to renewal applications)
11. Location Information:
13. Name of Partnership or Corporation:
14. Name of business for which license is requested (DBA):
16. Date of Incorporation:
17. State of ND Liquor License No.:
18. If out of state corporation, is corporation registered in North Dakota?

    1. Yes
    2. No
20. Location Address:
22. City:
23. State:
24. Zip:
25. Phone No.:
27. Owner of Building or Premises:
31. Correspondence Information (Where correspondence is to be sent):
33. Primary Contact:
34. Email Address:
36. Mailing Address:
37. City:
39. State:
40. Zip:
41. Phone No.:
45. List all officers or director of corporation or partners and percentage of ownership:
47. Manager's Name:
48. Date of Birth:
50. Driver's License No.:
51. State Issued:
52. Gender:
53. Race:
55. Home Address:
57. City:
58. State:
59. Zip:
60. Phone No.:
62. Occupation:
63. Title:
64. Email Address:
68. Name:
69. Date of Birth:
71. Driver's License No.:
72. State Issued:
73. Gender:
74. Race:
76. Home Address:
78. City:
79. State:
80. Zip:
81. Phone No.:
83. Occupation:
84. Title:
85. Email Address:
89. Name:
90. Date of Birth:
92. Driver's License No.:
93. State Issued:
94. Gender:
95. Race:
97. Home Address:
99. City:
100. State:
101. Zip:
102. Phone No.:
104. Occupation:
105. Title:
106. Email Address:
110. Name:
111. Date of Birth:
113. Driver's License No.:
114. State Issued:
115. Gender:
116. Race:
118. Home Address:
120. City:
121. State:
122. Zip:
123. Phone No.:
125. Occupation:
126. Title:
127. Email address:
129. Please submit all officers that will not fit on this form.
133. The undersigned states that the following information is true and correct.
135. 1. Are manager and partners legal residents of the United States and the State of North Dakota, and are all officers or directors legal residents of the United States?

     1. Yes
     2. No
137. 2. Have any of the persons listed above been convicted of any crime within the past five years?

     1. Yes
     2. No
139. If yes, list all convictions and the dates, locations and sentence of disposition of each:
141. 3. Does the building meet all state and local sanitation and safety requirements?

     1. Yes
     2. No
143. 4. Has applicant, or any of the persons listed above, within the past five years had any license to engage in sale of alcoholic beverages revoked or suspended?

     1. Yes
     2. No
145. If yes please, give details:
147. 5. If new application, have you ever engaged in the sale or transportation of alcoholic beverages previously?

     1. Yes
     2. No
149. If yes please, give details:
151. 6. Has applicant, or any of the persons listed above, within the past five years, had an application for any federal or state or local license of any type rejected or denied?

     1. Yes
     2. No
153. If yes please, give details:
155. 7. Is there any agreement or understanding, or proposed agreement or understanding to obtain the license for another, or to operate the business for another, or as an agent for another?

     1. Yes
     2. No
157. If yes please, give details:
159. 8. Has the business been sold or leased, or is there any intention to sell or lease the business to another?

     1. Yes
     2. No
161. If yes please, give details:
163. 9. Has the applicant, or any of the persons listed above, shown interest in whatsoever, directly or indirectly, any other license liquor establishment within or without the State of North Dakota?

     1. Yes
     2. No
165. If yes please, give details:
167. 10. Will the applicant, or any of the persons listed above, be engaged in any other business other than the sale of liquor under the license applied for?

     1. Yes
     2. No
169. If yes please, give details:
171. 11. Have all property taxes and special assessments currently due been paid?

     1. Yes
     2. No
173. If not please, explain why:
177. Restaurant Requirements:
179. All applications for Class “F”, Class “I” (restaurants), Class “M” (caterer), Class “P” (event site) and Class “Q” (Restaurant On-Sale and Off-Sale) licenses MUST be accompanied by a sworn statement executed by the licensee and a certified public accountant retained by the licensee certifying that gross food sales and liquor sales for the previous calendar year meet the requirements of Chapter 5-01-04 of the City Code of Ordinances.
181. Upload Gross Food Sales Report:
185. Liquor License Site Diagram Requirements:

     1. Site diagrams are to be submitted on a plain sheet of paper, 8½ x 11-inch size.
     2. The licensed area shall be identified within the margins.
     3. The agency name shall be included on the diagram.
     4. The direction “North” shall be included on the diagram.
     5. The interior design of the licensed area shall be represented. This should include entrances, exits, interior doors, windows, tables, coolers, storage offices and room dividers.
     6. The diagram may be hand drawn, but it must be neat and reasonably accurate.
     7. If the licensed site is part of a larger complex such as a restaurant, areas such as mixing, serving and storage must be identified.
187. Upload Site Diagram:*
191. I agree that I will not transfer or sell this license, if granted, without the prior approval of the governing body and in accordance with applicable ordinances,

     1. I agree
193. I also agree that should any of the information contained in this application change within the period of the license, if granted, that I will inform city officials immediately and furnish such details as may be requested by such officials concerning any such changes. I also agree that, should there be a change in ownership or management during the period of the license, prior approval of the Board of City Commissioners is required.

     1. I agree
195. I further agree that any misrepresentation, false statement or omission in this application shall be grounds for rejection of said application or for revocation or suspension of any license granted.

     1. I agree
197. Signature of Applicant:*
199. By checking this box I acknowledge that I am electronically signing this liquor license application.*

     1. Electronic Signature
200. Date:*
     Date:
204. Payment Options:
     -- Select One --Check By MailCredit Card Authorization FormCredit Card Payment Over The Phone - (701) 355-1300
206. Credit Card
     Credit Card Authorization Form
207. Upload Credit Card Authorization Form
209. Mail Payments To:
     City of Bismarck Administration, 221 North 5th Street, Bismarck, ND 58501
Leave This Blank:


211. 1. Receive an email copy of this form.
212. Email address

     This field is not part of the form submission.

213. Submit Submit and Print

* indicates a required field