Village of Lisle Form

Lisle Business Relief Program - On Premises Liquor License Renewal Fee

2. Under the Lisle COVID-19 Business Relief Program, Lisle businesses can apply for a grant that will reimburse them for 50% of their 2021 annual liquor license fee. This program is intended to assist those impacted by Tier 3 resurgence mitigations of the Restore Illinois plan.

   Under the Lisle COVID-19 Business Relief Program, Lisle businesses can apply for a grant that will reimburse them for 50% of their 2021 annual liquor license fee. This program is intended to assist those impacted by Tier 3 resurgence mitigations of the Restore Illinois plan.

3. 

7. SECTION I. BUSINESS INFORMATION

9. Business Name (DBA followed by Corporation or LLC )*

11. Lisle Business Address*

13. Business Phone (Including Area Code)*

15. Contact Name*

17. Contact E-mail Address*

19. Business License Number*

20. Federal ID # / EIN #*

22. Liquor License Number *

24. SECTION II. BUSINESS TYPE

26. Business Type*

    1. Restaurant/Bar

    1. Hotel/Motel

    1. Other

28. If other, please describe

30. SECTION III. MAILING ADDRESS & PHONE NUMBER

32. Enter Name if Different from Section I (above) or Enter Care-Of Name

34. Mailing Address

36. City, State, ZIP Code

37. Phone (Including Area Code)

39. SECTION IV. BUSINESS OWNER (APPLICANT) INFORMATION

41. Owner Name*

43. Home Address*

45. City, State, Zip Code*

46. Phone (Including Area Code)*

48. SECTION V. DECLARATION OF BUSINESS OWNER (APPLICANT)

50. I certify that the business identified above:*

    1. Has renewed their liquor license for calendar year 2021
    2. Has a current / non-expired State of Illinois Liquor License
    3. Has been negatively impacted by the executive orders which required business to close or have operations seriously curtailed
    4. Is currently conducting business
    5. Is not affiliated with another business under common ownership/management that has applied for grant funds

52. SECTION VII. BUSINESS OWNER (APPLICANT) SIGNATURE
    I certify that the statements made in this application are true and complete to the best of my knowledge.

    I certify that the statements made in this application are true and complete to the best of my knowledge.

54. Name*

55. Signature*

57. Title*

58. Date*

60. UPLOAD W-9 IRS TAX FORM*

62. For questions, email lislerelief@villageoflisle.org or call (630) 271-4135.

Leave This Blank:


64. 1. Receive an email copy of this form.
65. Email address

    This field is not part of the form submission.

66. Submit

* indicates a required field