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Renewal Licence 3-4
Reinstatement of Licence 5
1204E (2013/04) © Queen’s Printer for Ontario, 2013 Disponible en français Page 1 of 8
INSTRUCTIONS
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You must submit all of the required fees, forms and documents, or your application will be returned to
you.
The following items must be submitted for your application to be processed:
Application Fee
The application fee is listed on the attached “Fee Schedule”. Application fees can be paid by:
cheque payable to "Minister of Finance". Post-dated cheques are not acceptable.
money order payable to "Minister of Finance".
Visa, Mastercard or American Express. Complete the enclosed Credit Card Payment form.
If you are enclosing an application for a golf course endorsement please include
the appropriate fee.
All fees are non-refundable.
Licence number and/or establishment name must be clearly legible on cheque, money
order or credit card slip.
Application Form
all questions must be answered; if a question does not apply, print "N/A"
must be signed and dated by the applicant(s)
Change of Ownership
Your liquor sales licence renewal application will not be accepted if there has been a
change of ownership that has not been previously reported to the AGCO.
If there has been a change of ownership, you must submit a liquor sales licence transfer
application to the AGCO.
Expiry Date
Your liquor sales licence renewal application must be received by the AGCO on or before
the expiry date on your liquor licence.
If your renewal application is not received by the expiry date on your liquor licence, your
licence will expire and you can no longer sell or serve alcohol.
EXPIRED LIQUOR LICENCES CANNOT BE RENEWED.
If your liquor sales licence has expired, you may apply to reinstate your licence. Please
refer to the enclosed Reinstatement Application on page 16.
YOU ARE PROHIBITED, UNDER SECTION 5(1) OF THE LIQUOR LICENCE ACT,
R.S.O. 1990 c. L.19, FROM SELLING/SERVING ALCOHOL WITHOUT A VALID
LIQUOR LICENCE.
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You may apply to reinstate your liquor sales licence if:
1. The ownership of the establishment has not changed; and
2. The establishment has been licensed within the past six months; and
3. The boundaries of the licensed areas have not changed; and
4. The capacity of the establishment has not changed.
Upon review of your application, if additional information is required we will contact you.
The following items must be submitted for your application to be processed:
Application Fee
The application fee is listed on the attached “Fee Schedule”. Application fees can be paid by:
cheque payable to "Minister of Finance". Post-dated cheques are not acceptable.
money order payable to "Minister of Finance".
Visa, Mastercard or American Express. Complete the enclosed Credit Card Payment form.
If you are enclosing an application for a golf course endorsement please include
the appropriate fee.
All fees are non-refundable.
Licence number and/or establishment name must be clearly legible on cheque, money
order or credit card slip.
Application Form
all questions must be answered; if a question does not apply, print “N/A”
must be signed and dated by the applicant(s)
For information regarding business name registration please contact MGS toll free at
1 800 361-3223 or visit the website at: http://www.serviceontario.ca
Exact Address of Establishment (not mailing address) / Emplacement exact de l’établissement Tel. No. / No de téléphone
(pas l’adresse postale)
( ) —
Unit Number / Unité City, Town or Village / Ville ou village Postal Code / Code postal Fax No / No de télécopieur
( ) —
Mailing Address of establishment (if different from above) / Adresse postale de l’établissement (si différente de celle indiquée ci-dessus)
Street number / Street name / Nom de rue Street type / Direction /
Numéro Genre de rue Orientation de rue
Suite, Floor, Apt. Lot, Concession, Rural Route City, Town Municipality / Ville, village, municipalité Postal Code / Code postal
Bureau/étage/App.
Suite, Floor, Apt. Lot, Concession, Rural Route City, Town Municipality / Ville, village, municipalité Postal Code / Code postal
Bureau/étage/App.
Telephone No.(Home) / No de téléphone (domicile) Telephone No. (Work) / No de téléphone (travail) Fax No. / No de télécopieur
( ) — ( ) — ( ) —
1204 (2013/04) © Queen’s Printer for Ontario, 2013 / © Imprimeur de la Reine pour l’Ontario, 2013 Page 6 of/de 8
4. Has the establishment name changed? / Le nom de l’établissement a-t-il changé?
If YES, the new name is: / Si OUI, le nouveau nom est :
Yes / No /
Oui Non
5. Have the boundaries of the licensed areas changed since the last time the liquor sales licence was issued
(not including cosmetic changes such as redecorating or painting)? / Les limites de la zone pourvue du Yes / No /
permis ont-elles changé depuis la dernière fois que le permis de vente d’alcool a été délivré (sans tenir Oui Non
compte des changements esthétiques tels que la décoration ou la peinture)?
If YES, please provide details. / Dans l’affirmative, fournir des détails.
You may be required to submit an Application for Changes or Additions to Licensed Areas – Form # 1221 /
Vous devrez peut-être fournir le formulaire 1221, Demande de modifications aux zones pourvues d'un
permis ou d'ajout à ces zones, dûment rempli.
6. Have you or any individual involved in the licence been charged or convicted of any offences in any
Yes / No /
jurisdiction within the previous four years? You must include any absolute and conditional discharges
and any outstanding charges. / Avez-vous déjà été, vous ou toute personne liée au permis, accusé ou
Oui Non
reconnu coupable d'une infraction dans quelque territoire que ce soit au cours des quatre dernières
années? Veuillez inclure une libération conditionnelle, une libération inconditionnelle ou des
accusations en instance.
If YES, complete and submit a Personal History Report – Form # 2075 / Dans l’affirmative, veuillez fournir le formulaire 2075,
Renseignements personnels, dûment rempli.
7. Who will manage the day-to-day operation of the liquor business at this establishment? /
Qui gérera les activités quotidiennes de l’établissement?
Self / Other (Please specify) /
Mois-même Autre (veuillez préciser)
Must complete and submit a Personal History Report Form 2075 /
doit fournir le formulaire 2075, Renseignements personnels, dûment rempli.
8. Have there been any changes, additions and/or deletions to officers and/or directors of the corporation? /
Yes / No /
Y a-t-il eu des changements, des ajouts ou des retraits quant aux dirigeants ou administrateurs de la société?
If YES, complete and submit a Corporate Structure Form # 2071 / Dans l’affirmative, veuillez fournir le formulaire 2071, Structure
Oui Non
organisationnelle, dûment rempli.
New officers and/or directors must also submit a Personal History Report. / Les nouveaux dirigeants ou
administrateurs doivent aussi fournir le formulaire Renseignements personnels dûment rempli.
9. Have there been any changes, additions and/or deletions to the shareholders of the corporation? / Yes / No /
Y a-t-il eu des changements, des ajouts ou des retraits quant aux actionnaires de la société?
If YES, complete and submit a Corporate Structure Form # 2071 / Dans l’affirmative, veuillez fournir le formulaire Structure
Oui Non
organisationnelle dûment rempli.
NOTE: A Liquor Sales Licence Transfer Application - Form # 1203B will be required for the addition of
shareholders with 10% or more shares / REMARQUE : Les nouveaux actionnaires détenant 10 % ou plus
des actions doivent fournir le formulaire 1203B, Demande de cession de permis de vente d'alcool, dûment
rempli.
10. Will any person and/or organization other than those involved in the ownership receive 15% or more of Yes / No /
the profits related to the sale of liquor? / Est-ce qu’une personne ou une organisation autre que celles
qui sont en cause dans la propriété recevront 15 % ou plus des profits réalisés grâce à la vente
Oui Non
d’alcool?
If YES, attach a copy of the management agreement. / Dans l’affirmative, veuillez joindre une copie de l’entente de gestion.
By signing this form I/we solemnly declare that all information provided in this application is true and correct. /
En signant cette formule, je déclare (nous déclarons) solennellement que les renseignements fournis sont fidèles et exacts.
Print name / Nom en lettres moulées Signature Date
Notification
The above information is collected pursuant to the Liquor Licence Act, R.S.O. 1990, c. L.19, as amended. The
principal purpose of the collection is to determine eligibility for the issuance of a liquor sales licence. The
information may also be disclosed pursuant to the Freedom of Information and Protection of Privacy Act, R.S.O.
1990, c. F.31. For questions about the collection of this information, please contact the Manager, Liquor Licensing,
Alcohol and Gaming Commission of Ontario, 90 SHEPPARD AVE E, SUITE 200, TORONTO ON M2N 0A4,
telephone 416 326-8700, toll free in Ontario 1 800 522-2876. Email address: Licensing@agco.ca
Avis
Les renseignements fournis dans la présente formule sont recueillis aux termes de la Loi sur les permis d’alcool,
L.R.O. 1990, chap. L.19, telle que modifiée, dans le but premier de déterminer l’admissibilité à un permis de vente
d’alcool. Ces renseignements peuvent également être divulgués aux termes de la Loi sur l’accès à l’information et la
protection de la vie privée, L.R.O. 1990, chap. F.31. Les questions relatives à la collecte de renseignements doivent
être adressées à la ou au chef du Service de délivrance des permis d’alcool et de circonstance, Commission des
alcools et des jeux de l’Ontario, 90 AV SHEPPARD E, BUREAU 200, TORONTO ON M2N 0A4. Tél. : 416 326-8700
ou 1 800 522-2876 (interurbains sans frais en Ontario). Courriel : Licensing@agco.ca