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Original Author: Hardy, Pat
Date of Material: 01/11/2016

Subjects(s):
Alcoholic beverages--Forms
Alcoholic beverages--Laws and regulations

Certificate of Compliance for Wine in Grocery Stores

Reviewed Date: 07/15/2021
Summary:
MTAS was asked to supply a certificate of compliance for selling wine in grocery stores.


CITY OF (______________) CERTIFICATE OF COMPLIANCE

RETAIL FOOD STORE WINE
(store name) – (address)



This is to certify that:

Name of Applicant: ____________________________________________________
Corporation Name: ____________________________________________________
Business Address: ____________________________________________________
____________________________________________________

Mailing Address: ______________________________________________________
______________________________________________________
______________________________________________________

Date of Birth ____________________

Had made application for a Certificate of Compliance to sell retail food store wine in the County of (______), State of Tennessee, City of (______) at (store address).

And that an investigation has been undertaken of the applicant’s felony criminal record and of the location of said business, and from said investigation the undersigned certify:

1. That the applicant or applicants who are to be in actual charge of the business have not been convicted of a felony within a ten-year period immediately preceding the date of application and, if a corporation, that the executive officers or those in control have not been convicted of a felony within a ten-year period immediately preceding the date of the application; and

2. That the applicant or applicants have secured a location which lies within the city limits of the City of (_______) and which complies with all applicable zoning laws adopted therein by the City.

Signed this ________ day of _________________________, _________


_____________________________________
Mayor, City of (_______)



ATTEST: ___________________________________________
City Clerk or Recorder

Reference Document(s)
file Cert of Compliance-Wine in grocery stores.docx
Attachments:
file Cert of Compliance-Wine in grocery stores.pdf