2. Town of Middleton Application for Special Home Rule License 2023

   Please use this form to apply for a Special Legislation liquor license for 2023. Please remit a full and complete application by close of business April 18, 2023. License fees shall be paid by either cashier’s check, bank check or online. Your packet must be complete and all fees paid in order to be considered by the Select Board at a scheduled meeting. 

   Please do not submit any sensitive information (drivers license, social security, passport number, banking information, etc.) through this platform. Instead, deliver to Select Board, 48 South Main Street, Middleton.  

4. General Information
6. Business Name*
7. DBA (Doing Business As)*
9. Business Address*
10. Business Manager Name*
12. Mailing Address (if different)
13. License Manager of Record*
15. Business Phone*
16. Manager Email Address*
18. Checklist - Special Legislation Home Rule License 2023 - Please complete all items listed below

20. Massachusetts ABCC retail license application - completed, signed with all required attachments.  Find application and procedure here -   https://www.mass.gov/alcoholic-beverages-retail-licenses

21. Upload ABCC retail complete application
23. Town of Middleton Fee Schedule
    Fee Schedule for Alcoholic Beverage Special Legislation Home Rule Licenses 2023
24. Upload Town of Middleton Fee Schedule
26. If applicable, Town of Middleton Common Victualler Application (On Premise Only)
    Common Victualler Application
27. If applicable, upload Common Victualler application
29. If applicable, Town of Middleton Entertainment Application (On Premise Only)
    Entertainment Application
30. If applicable, upload Entertainment application
32. If applicable, Town of Middleton Automatic Amusement Device application (On Premise Only)
    Automatic Amusement Device application
33. If applicable, upload Automatic Amusement Device application
35. Fees

    All fees need to be paid to the Town of Middleton upfront by check or online https://unipaygold.unibank.com/transactioninfo.aspx

    
    

37. Town of Middleton Home Rule Petition Questionnaire
    Questionnaire
38. Upload Questionnaire
40. Upload Liquor License Liability Insurance Certificate
41. Upload Fire Inspection Certificate (On Premise Only)
42. Upload Building Inspection Certificate (On Premise Only)
44. Employee Training Form if serving or selling alcohol (TIPS) (On Premise Only)
    TIPS Affidavit
45. Upload Tips Affidavit and Certifications
47. REAP Certification
    REAP Certification

    Pursuant to Massachusetts General Laws, Chapter 62C, Section 49A, I hereby certify under the penalties of perjury that I to my best knowledge and belief, have filed all State tax returns and paid all state taxes required by law.

48. Upload Signed Revenue Enforcement and Protection Certification
50. Town of Middleton Fees, Taxes and Other Charges*

    Are all fees, taxes and other municipal charges paid and current?  This includes personal property, property tax, utility bills (MELD and Danvers water). 

    1. Yes
    2. No
56. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
58. Electronic Signature*
59. Date*
    Date
Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit Submit and Print

* indicates a required field