The following statutes affect this form: s. 125.12 (3m), Wis. stats. STATE OF WISCONSIN
Town of ________
________ County
To ________ ________:
It appearing to the Town Board of the Town of ________, ________ County, Wisconsin, that a Class [A or B or C] alcohol beverage license should not be issued to you for the reason that [specify the grounds for denial], you are notified that said license will not be issued.
Dated this ______ day of ________, 20__.
[Signatures of town board]
Attest: [Signature of town clerk]
The following statutes affect this form: s. 125.17, Wis. stats. I, ________ ________, of ______________, make application for an operator’s license under s. 125.17, Wis. stats., to sell alcohol beverages in a place operated for the sale of alcohol beverages, and I agree that I will comply with all laws, resolutions, ordinances, and regulations, state, federal, and local, affecting the sale of alcohol beverages, if a license is granted to me. I certify that I am a person over 18 years of age and that I have successfully completed a responsible beverage server training course.
Dated this ______ day of ________, 20__.
[Signature of applicant]
Note: See s. 125.17 (4) and (5), Wis. stats., for issuance of temporary and provisional operator’s licenses. The following statutes affect this form: s. 125.17, Wis. stats. STATE OF WISCONSIN
Town of ________
________ County
Application having been filed by ________ ________, of ______________, for an operator’s license under s. 125.17, Wis. stats., and it appearing that the applicant is a person over 18 years of age who has successfully completed a responsible beverage server training course [if the town has adopted an ordinance pursuant to s. 125.17 (5) (a), Wis. stats., regarding licensing standards, add: and meets all the standards established by ordinance by the Town of ________] and has paid the required fee of $________; An Operator’s License is granted to ________ ________ to sell alcohol beverages in a place operated for the sale of alcohol beverages in the Town of ________, ________ County, Wisconsin.
This license expires on June 30, 20__, unless sooner revoked.
Dated this ______ day of ________, 20__.
[Signatures of town board]
Attest: [Signature of town clerk]
Note: See s. 125.04 (5) and (6), Wis. stats., for license qualifications. See ss. 125.32 and 125.68, Wis. stats., for general license restrictions and requirements. The following statutes affect this form: s. 125.17 (1), Wis. stats. Note: Section 125.17 (1), Wis. stats., allows town boards to designate by ordinance municipal officials to issue operators’ licenses. The Wisconsin Towns Association has developed a sample ordinance designating municipal officials as officials authorized to issue operators’ licenses. Electronic copies of the sample ordinance may be found in the Ordinances and Resolutions section of the Information Library of the Town Association website at: The following statutes affect this form: s. 125.17 (5) (a) 1., Wis. stats. Note: Section 125.17 (5) (a) 1., Wis. stats., requires town boards that issue operators’ licenses to issue provisional operators’ licenses. In doing so, the town board may adopt an ordinance setting forth the standards under which these provisional licenses may be issued. The Wisconsin Towns Association has developed a sample provisional operator’s license ordinance. Electronic copies of the sample ordinance may be found in the Ordinances and Resolutions section of the Information Library of the Towns Association website at: The following statutes affect this form: s. 125.185, Wis. stats. Note: Section 125.185, Wis. stats., requires town boards that issue retail alcohol licenses to issue provisional retail alcohol licenses. In doing so, the town board may adopt an ordinance setting forth the standards under which these provisional licenses may be issued. The Wisconsin Towns Association has developed a sample provisional retail alcohol license ordinance. Electronic copies of the sample ordinance may be found in the Ordinances and Resolutions section of the Information Library of the Towns Association website at: The following statutes affect this form: s. 125.25, Wis. stats. STATE OF WISCONSIN
Town of ________
________ County
________ ________, of the Town of ________, ________ County, Wisconsin, having filed with the undersigned town clerk an application for a retailer’s Class “A” license to sell fermented malt beverages, that has been published as required by s. 125.04 (3), Wis. stats., and having produced a receipt showing the payment of $________ to the treasurer of the town, and the application having been granted by the town board on ________ ___, 20__; A retailer’s Class “A” license is granted to ________ ________ to sell fermented malt beverages under s. 125.25, Wis. stats., on the following premises in the town only for consumption off the premises where sold and in the original packages, containers, and bottles: [describe them]. This license will expire on June 30, 20__, unless sooner revoked.
Dated this ______ day of ________, 20__.
[Signatures of town board]
Attest: [Signature of town clerk]
Notes: See ss. 125.04 (5) and (6) and 125.25 (2) (b), Wis. stats., for provisions regarding applications and qualifications for licenses. See s. 125.32, Wis. stats., for general license restrictions and requirements. Licenses for months or fractions of months may be granted, with prorated fees under s. 125.25 (4). The following statutes affect this form: s. 125.26, Wis. stats. STATE OF WISCONSIN
Town of ________
________ County
________ ________, of the Town of ________, ________ County, Wisconsin, having filed with the undersigned town clerk an application for a retailer’s Class “B” license to sell fermented malt beverages, that has been published as required by s. 125.04 (3), Wis. stats., and having produced a receipt showing the payment of $________ to the treasurer of the town, and the application having been granted by the town board on ________ ___, 20__[fee shall not exceed $100 per year; nonrenewable license may be issued for 6 months for one half of the license fee]; A retailer’s Class “B” license is granted to ________ ________ to sell fermented malt beverages, under s. 125.26, Wis. stats., on the following premises in the town either to be consumed on the premises where sold or off the premises: [describe the premises]. This license will expire on June 30, 20__, unless sooner revoked.
Dated this ______ day of ________, 20__.
[Signatures of town board]
Attest: [Signature of town clerk]
Notes: See ss. 125.04 (5) and (6) and 125.26 (2) (b), Wis. stats., regarding applications and qualifications for licenses. See s. 125.32, Wis. stats., for general license restrictions and requirements. Six-month licenses and licenses for months or fractions of months may be granted, with prorated fees under s. 125.26 (4) or (5). The following statutes affect this form: s. 125.26 (6), Wis. stats. STATE OF WISCONSIN
Town of ________
________ County
Written application having been made to the Town Board of the Town of ________, ________ County, Wisconsin, by ________ [name of bona fide club, county or local fair association or agricultural society, church, lodge, or society that has been in existence for at least 6 months before the date of application, or veterans’ organization posts] for a Temporary Class “B” License to sell fermented malt beverages for the period and at the premises described in the application, and the applicant having paid the required fee of $________ [not to exceed $10];
A Temporary Class “B” License is granted to ______________ to sell at retail at the following premises: [describe them], for the following period: [state period], fermented malt beverages subject to the limitations imposed by law. [If applicable, state: Licensee is authorized to permit underage persons to be upon the described premises during the effective period of this license.]
Dated this ______ day of ________, 20__.
[Signatures of town board]
Attest: [Signature of town clerk]
The following statutes affect this form: ss. 125.26 (6) and 125.51 (10), Wis. stats. Note: The Wisconsin Towns Association has developed a sample temporary retail alcohol license ordinance setting forth standards under which the clerk or his or her designee may issue temporary Class “B” beer and temporary “Class B” wine licenses, also known as “picnic licenses,” without prior town board approval. Electronic copies of the sample ordinance may be found in the Ordinances and Resolutions section of the Information Library of the Towns Association website at:
The following statutes affect this form: s. 125.51 (2), Wis. stats. STATE OF WISCONSIN
Town of ________
________ County
________ ________, of the Town of ________, ________ County, Wisconsin, having filed with the undersigned town clerk an application for a Retail “Class A” license to sell intoxicating liquor, that has been published as required by s. 125.04 (3), Wis. stats., and having produced a receipt showing the payment of $________ to the treasurer of the town, and the application having been granted by the town board on ________ ___, 20__; A Retail “Class A” license is granted to ________ ________ to sell intoxicating liquor under s. 125.51 (2), Wis. stats., on the following premises in the town only for consumption off the premises where sold and in the original packages, containers, and bottles: [describe them]. This license will expire on June 30, 20__, unless sooner revoked.
Dated this ______ day of ________, 20__.
[Signatures of town board]
Attest: [Signature of town clerk]
Note: Six-month licenses and licenses for months or fractions of months may be granted, with prorated fees under s. 125.51 (9). The following statutes affect this form: s. 125.51 (3), Wis. stats. STATE OF WISCONSIN
Town of ________
________ County
________ ________, of the Town of ________, ________ County, Wisconsin, having filed with the undersigned town clerk an application for a Retail “Class B” license to sell intoxicating liquors, that has been published as required by s. 125.04 (3), Wis. stats., and having produced a receipt showing the payment of $________ to the treasurer of the town, and the application having been granted by the town board on ________ ___, 20__; A Retail “Class B” license is granted to ________ ________ to sell intoxicating liquors under s. 125.51 (3), Wis. stats., to be consumed by the glass only on the premises licensed and not in the original package or container, except wine may be sold in the original package or otherwise in any quantity to be consumed off the premises and intoxicating liquors may be sold by the glass for consumption off the premises if the licensee seals the container of intoxicating liquor with a tamper-evident seal before the intoxicating liquor is removed from the premises, on the following premises: [describe the premises]. This license expires on the last day of June, 20__, unless sooner revoked.
Dated this ____ of ________, 20__.
[Signatures of town board]
