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2. City of Middleton Operator License Application
4. Filling out your application:

   An operator license is a privilege, not a right.  Any false answers or omissions may result in the denial of your application.

   The City of Middleton will perform a background check to verify that the information you provided is complete and accurate.

   This application must be filled out completely and accurately.  All fees are non-refundable.

6. License Type*

   Select the type of license you are applying for.

   1. New $50

   1. Renewal $50

   1. Provisional $65
8. First Name*
9. Last Name*
11. Former Name or Aliases
13. Address, City, State Zip*
15. Previous Address, City, State Zip*
17. Phone Number*
18. E-mail address*
20. Establishment where you will use the license*
21. Contact Person & Phone Number*
23. Driver's License or Identification Card*

    Please upload a copy of your current driver's license or state issued identification card.

27. *Renewals - Please only list the violations since your last application.
29. Have you ever been convicted of a felony or misdemeanor (including criminal traffic offense)?*

    1. Yes

    1. No
31. Have you been arrested for, received a summons to appear in court for, or paid a fine for any of the following?

     For multiple charges, attach additional pages.

32. Upload any additional pages here
34. Any underage alcohol violation?*

    1. Yes

    1. No
35. Year
36. City/State
38. Operating a motor vehicle while intoxicated?*

    1. Yes

    1. No
39. Year
40. City/State
42. Selling or furnishing alcoholic beverages to underage person?*

    1. Yes

    1. No
43. Year
44. City/State
46. Permitting underage person on licensed premise?*

    1. Yes

    1. No
47. Year
48. City/State
50. Allowing person on licensed premises after closing?*

    1. Yes

    1. No
51. Year
52. City/State
54. Any alcohol related violation other than those listed above?*

    1. Yes

    1. No
55. Year
56. City/State
58. Sale or possession of drugs any kind?*

    1. Yes

    1. No
59. Year
60. City/State
62. Fighting, disorderly conduct, assault, or battery?*

    1. Yes

    1. No
63. Year
64. City/State
66. Resisting arrest or obstructing an officer?*

    1. Yes

    1. No
67. Year
68. City/State
72. List ALL and ANY convictions, citations, tickets, and pending charges not identified above.
73. If none, initial here:
75. Type of arrest, summons, violation, or charge
76. Year
77. City/State
79. Type of arrest, summons, violation, or charge
80. Year
81. City/State
83. Type of arrest, summons, violation, or charge
84. Year
85. City/State
89. Within the last 2 years, did you have or complete one of the following?*

    1. Held Operator's License in WI?
    2. Was or currently an agent for a retail alcohol license?
    3. Was or currently a sole proprietor for a retail alcohol license?
    4. Successfully completed responsible alcohol server course? (upload certificate below)
91. Upload responsible beverage server class completion certificate
93. Payment Method*

    1. Online - Select Operator's License (Bartenter/Server) from Payment Page Dropdown Menu
    2. Mailing Check

    Once you hit submit, you will be directed to the credit card processing page.  You may also mail a check to our office at 7426 Hubbard Avenue, Middleton, WI  53562.

97. I attest that the above information is true and correct and that any false or incomplete information may result in denial of my application.
99. By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.
100. Initial here *
102. Please Type Name as Shown on Application Above*
103. Date*
     Date
Leave This Blank:


105. 1. Receive an email copy of this form.
106. Email address

     This field is not part of the form submission.

107. Submit

* indicates a required field