The City of Wheeling, West Virginia

I, the undersigned, do certify that the information given herein is, to the best of my knowledge and belief, true and correct.
* First Name:
* Last Name:
Applicant’s Title:
Phone:
* E-mail:
Fax:
Contact Preference:
Application of: Business Name:

Address:	City:	County:
Address:	State:	ZIP:

Name of Owner and Operator:
Certification and Application for Licenses As Listed Below: City Treasurer, Wheeling, West Virginia 26003
Please List All Classificatioins, Descriptions and Fees that Apply. See "Business Codes, Descriptions and Fees" below.:
Licenses are issued on an annual basis. Failure to secure new license on or before July 1st, or the operation of devices prior to obtaining license, will cause a penalty of 10% of the annual fee to be added for each month or fractional part delinquent.
Total Cost:
Penalty:
Total Remittance:
Read Instructions Below Before Completing Application.

1. To simplify completing this application, detach the application (’upper part) from the Instructions (lower part) on the perforation above the instruction heading.

2. Complete the Business Name & Address. If already completed review the data is correct, making corrections as required.

3. Enter names of Owner and Operator if this is not part of business name (item 2).

4. Enter telephone number of this business. Also enter an alternate or residence phone number of the business’s owner or manager or of an individual if application is not for a business. Indicate relationship of number entered (Individual, Owner, Manager).

The section at the right of the application is for listing the detailed items for which you are making application. Review any items already listed making corrections to any items that are incorrect or no longer apply.

6. Enter new items which have been added since your last application or ail items if this is a new application. Refer to the fee listing on the reverse side of this instruction sheet for the different fees and their descriptions.

CONSULT CITY LICENSE OFFICER FOR RATES NOT SHOWN ON APPLICATION.

7. (a) Enter "TOTAL COST" of all fees you have listed.
(b) Enter any PENALTY which may be required. Penalty requirements stated at left of penalty entry area.
(c) Enter TOTAL REMITTANCE required for this application.

8. If application is for (1) Special Store, (2) General Store, or (3) Coin Operated Merchandise or Service Devices be sure to read note A, B and C on back of application for additional information.

9. If application is for a BEER LICENSE, section E on back of application must be completed.

10. If application is for a PRIVATE CLUB LICENSE section F on back of application must be completed in detail.

APPLICATIONS FOR PRIVATE CLUB LICENSES MUST BE NOTARIZED in the space provided in section F.

11. A remarks area (section D, on back of application) has been provided for additional information which may be required or for items which you wish to call to ihe attention of the license officer.

12. Sign and Date (also include title) in the area provided on the front of this application.

13. Make check (or money order) payable to CITY OF WHEELING for the amount entered in TOTAL REMITTANCE.

14. Review application making sure all information has been properly entered and that any additional item(s) (as requested) are included.

INCOMPLETE OR MISSING INFORMATION MAY CAUSE A DELAY IN THE PROCESSING OF YOUR APPLICATION.

15. For your records enter the following and retain this information until you receive your license : Check Number, Total Remittance, Application Number

*Application Number is located on front (upper right side) on renewal applications only.

16. Deliver (or mail) application, check, and additional items (if required) to:

CITY/COUNTY BUILDING
WHEELING, WV 26003
PHONE NO. 304-234-3653
NOTES
D. Remarks/Additional Information
E. Beer License-Additional Information

When applying bring your State Beer License with you or send a copy of your license when applying by mail or online.
WV State Beer License Number:
F. Private Club License - Additonal Information
F. Club Phone Number:
F. Current Membership:
F. Club Type:
Corporation
Association

Address:	City:	County:
Address:	State:	ZIP:

F. Property Owners:
F. Names and Addresses:
F. Club Officers (Name, Address, Birthdate, Years WV Resident)
President:
Vice-Pres.:
Secretary:
Treasurer:
Manager:
Enter arrest record of officers, past or present, not shown on last year’s application. If there have been no arrests, check ’none.’
F. Are There Club Officer Arrest Not Show on Last Year’s Application:
Yes
No
F. Club Officer Arrests
If there have been any arrests, please give this information in the remarks section of this form.
Name, Date of Arrest, Charge, Disposition of Arrest and Current Location:
Has your club license ever been suspended?:
Yes
No
Has your club license ever been revoked?:
Yes
No
List WV A.B.B.C. License No.:
F. Max Seating Capacity:
F. WV Consumer Sales Tax ID #:
F. Business Franchise Tax #:
Health Permit #:
General Licensing Category:
$15 - General Business License
$100 - Insurance Companies, which by state law are exempt from Business and Occupation Tax. Note: Insurance Agents are classified under General Business License fee.
ABCA Related Licensing Category:
$250.00 - Beer/Wine/Liquor Retailer (ABCA Retailers)
$500.00 - Beer/Wine/Liquor Wholesalers (ABCA Wholesalers)
$600.00 - Private Clubs, Fraternal Organizations, Non-Profit, Social, other (ABCA Private Clubs) Less Than 1,000 Members
$1,250.00 - Private Clubs, Fraternal Organizations, Non-Profit, Social, other (ABCA Private Clubs) More Than 1,000
Transient Category:
$500.00 - Itinerant Vendors