Form 50 "Application for Approval of Car Park Use" - Queensland, Australia

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Form 50
Application for approval of car park use
Liquor Act 1992 s. 142ZZF • V3 2016
Instructions
Warning
Office use only
This application only applies where the car park
False or misleading statements will attract a
already forms part of the licensed premises.
maximum penalty of 100 penalty units or six
Date ....................................
months imprisonment and may lead to immediate
Please complete in BLOCK letters. Attach extra
Rec no. ................................
cancellation of application.
pages if needed. If you need help completing this
Amount $ .............................
form, contact the Office of Liquor and Gaming
Fees
Initials ................................
Regulation (OLGR) on 13 QGOV (13 74 68)
To find out the current application fee go to
or visit our website
www.business.qld.gov.au/liquor-gaming (see
www.business.qld.gov.au/liquor-gaming
Application for temporary variation of licence fee)
Part A—Requirements
The Liquor Regulation 2002 s. 5, states this application must be lodged 21 days before the first event
date stated in this application.
This form should be completed by licensees seeking approval to use the car park which currently forms
part of their licensed premises. If you are seeking approval for use of an unlicensed car park, you need
to complete Form 16 Application for temporary change in licensed area.
Part B—Details
Section 1
Licensee name ......................................................................................................................................
as shown on licence document
Licensee details
Street address .....................................................................................................................................
Suburb ................................................................................. State
Postcode
Phone ................................................................. Fax ..........................................................................
Mobile ................................................................ Email .......................................................................
Section 2
Premises name .....................................................................................................................................
Premises details
Premises address .................................................................................................................................
Suburb ................................................................................. State
Postcode
Phone ................................................................. Fax ..........................................................................
Mobile ................................................................ Email .......................................................................
Section 3
Liquor licence no. .................................................................................................................................
as shown on licence document
Licence no.
Section 4
Name of function/event .......................................................................................................................
Function/event type
Type of function/event .........................................................................................................................
Office of Liquor and Gaming Regulation
Page 1 of 5
Form 50
Application for approval of car park use
Liquor Act 1992 s. 142ZZF • V3 2016
Instructions
Warning
Office use only
This application only applies where the car park
False or misleading statements will attract a
already forms part of the licensed premises.
maximum penalty of 100 penalty units or six
Date ....................................
months imprisonment and may lead to immediate
Please complete in BLOCK letters. Attach extra
Rec no. ................................
cancellation of application.
pages if needed. If you need help completing this
Amount $ .............................
form, contact the Office of Liquor and Gaming
Fees
Initials ................................
Regulation (OLGR) on 13 QGOV (13 74 68)
To find out the current application fee go to
or visit our website
www.business.qld.gov.au/liquor-gaming (see
www.business.qld.gov.au/liquor-gaming
Application for temporary variation of licence fee)
Part A—Requirements
The Liquor Regulation 2002 s. 5, states this application must be lodged 21 days before the first event
date stated in this application.
This form should be completed by licensees seeking approval to use the car park which currently forms
part of their licensed premises. If you are seeking approval for use of an unlicensed car park, you need
to complete Form 16 Application for temporary change in licensed area.
Part B—Details
Section 1
Licensee name ......................................................................................................................................
as shown on licence document
Licensee details
Street address .....................................................................................................................................
Suburb ................................................................................. State
Postcode
Phone ................................................................. Fax ..........................................................................
Mobile ................................................................ Email .......................................................................
Section 2
Premises name .....................................................................................................................................
Premises details
Premises address .................................................................................................................................
Suburb ................................................................................. State
Postcode
Phone ................................................................. Fax ..........................................................................
Mobile ................................................................ Email .......................................................................
Section 3
Liquor licence no. .................................................................................................................................
as shown on licence document
Licence no.
Section 4
Name of function/event .......................................................................................................................
Function/event type
Type of function/event .........................................................................................................................
Office of Liquor and Gaming Regulation
Page 1 of 5
Section 5
No. of bars ..........................................................................................................................................
Car park area
Size of consumption area ....................................................................................................................
details
How is the area to be defined?
.......................................................................
(e.g. rope, temporary fencing)
............................................................................................................................................................
Additional information
......................................................................................................
(if applicable)
............................................................................................................................................................
Section 6
When do you intend to use the car park?
Period of approval
Car park event
Date
Time
The maximum period an
application can be made
for is 3 months.
The car park approval fee
is for a maximum of
3 consecutive days.
A separate fee is
applicable for each
consecutive three day
period (or part thereof ).
Section 7
What is the estimated attendance at the event/function for each day of the proposed period? .............
Attendance details
............................................................................................................................................................
Section 8
Will the event/function involve entertainment?
Entertainment
F No
details
F Yes —give details of the type(s) of entertainment .....................................................................
............................................................................................................................................................
If this has any impact on the currently endorsed licence conditions, the applicant must also apply for a Form 17,
Temporary variation of licence. Form is available from www.business.qld.gov.au/liquor-gaming
Section 9
How many security staff will be provided
?
(complete each box below)
Security
roaming car park area
stationed at entrance
stationed at liquor servery area
Section 10
How will liquor be served?
Liquor served
F cans
F bottles
F disposable cups
F glasses
Office of Liquor and Gaming Regulation
Page 2 of 5
Section 11
Attach a layout plan showing the car park area in relation to the main premises and include details of
service points, entries, exits and toilet facilities. Is plan attached?
Plan of car park
area to be used
F No —do not proceed with this application until the plan is attached
F Yes
Section 12
You must lodge an updated RAMP which includes changes relating to this application. Please refer
to Guideline 42 which is available on our website www.business.qld.gov.au/liquor-gaming, for
Risk assessed
assistance in completing this document.
management plan
(RAMP)
Is your RAMP attached?
F No—do not lodge this application until the RAMP is available and attached
F Yes
Section 13
I .......................................................................... of .............................................................. station
Police consent
/
/
Received this application on
F I object (a written report outlining reasons for officer’s objection must accompany this
application)
F I do not object to this application to use the car park
Name ................................................................................................................................................
Position ............................................................................................................................................
/
/
Signature ............................................................ Date
Section 14
I declare/certify that:
Declaration and
1. The information in this application and any attachments are true and correct and
licensee/authorised
2. My lodgement of this application is not a guarantee that the application will be successful.
representative
signature
Name ....................................................................................................................................................
Signature .............................................................................................................................................
/
/
Date
Office of Liquor and Gaming Regulation
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Office of Liquor and Gaming Regulation
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Part C—Lodgement and fee payment
Section 15
Please lodge the completed application, any supporting documentation and fees with OLGR at
the address below or any OLGR office at Gold Coast (Southport), Sunshine Coast (Maroochydore),
Lodgement and
Toowoomba, Wide Bay, Rockhampton, Mackay, Townsville or Cairns. Call 13 QGOV (13 74 68) for
payment
addresses or visit our website www.business.qld.gov.au/liquor-gaming
By mail:
In person:
Office of Liquor and Gaming Regulation
Office of Liquor and Gaming Regulation
Locked Bag 180
Upper Plaza, 33 Charlotte Street
CITY EAST QLD 4002
BRISBANE QLD 4000
Payment type:
F Money order—
make money order payable to Office of Liquor and Gaming Regulation
F Cheque—
make cheque payable to Office of Liquor and Gaming Regulation
F Credit card*—charge my:
Mastercard
VISA
Credit card no.
Cardholder’s name ..............................................................................................................................
Amount authorised $ .......................................... Expiry date .............................................................
Cardholder’s signature ........................................................................................................................
A receipt will not be issued unless specifically requested.
*OLGR will not accept credit card details by fax or email, including PDF attachments. If an email is received with credit card details, it
will be deleted immediately and your form will not be processed. This is in accordance with the Payment Card Industry Data Security
Standard.
OLGR is collecting your personal information in order to assess your application for the use of the car park for an event/function in accordance with Liquor Act 1992
s. 142ZZF which requires/allows for the collection of the personal information. OLGR may disclose this information to the local council, local police and in some instances,
the owner of the car park.
Office of Liquor and Gaming Regulation
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