Application for Adult-Oriented Establishments
Loudon County, Tennessee

Date of Application:__________________

1) Name (Applicant including all Alias's):_____________________________________

_____________________________________________________________________

2) All applicant's must supply written proof of age that the applicant is eighteen (18) years of age. Please attach a copy of:

a) Driver's License
b) Birth Certificate

3) List the businesses, occupations and employment of the applicant in an adult-oriented establishment for five (5) years immediately preceding the date of the application:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

4) List the adult-oriented establishment or similar business license history of the applicant; whether such applicant, in previously operating in this or any other county, city or state under license, has had such license revoked or suspended, the reason therefore, and the business activity or occupation subject to such action of suspension or revocation:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
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5) List any conviction for or plea of nolo contendere to a specified criminal act as defined in TCA 7-51-1102(24): (Listed below):
"Specified criminal acts" means the following criminal offenses as defined by Tennessee Code Annotated:
a) Aggravated rape; (b) Rape; (c) Rape of a child; (d) Aggravated sexual battery; (e) Sexual battery by an authority figure; (f) Sexual battery; (g) Statutory rape; (h) Public indecency; (i) Prostitution; (j) Promoting prostitution; (k) Distribution of obscene materials; (l) Sale, loan or exhibition to a minor of material harmful to minors; (m) The display for sale or rental of material harmful to minors; (n) Sexual exploitation of a minor; (o) Aggravated sexual exploitation of a minor; and (p) Especially aggravated sexual exploitation of a minor

_____________________________________________________________________
_____________________________________________________________________
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6) The address of the adult-oriented establishment to be operated by the applicant:
_____________________________________________________________________
_____________________________________________________________________

a) Location Requirements: All adult oriented establishments must comply with Loudon County zoning regulations.
7) If the applicant is a corporation, the application shall specify the name, address, and telephone number of the corporation, the date and the state of incorporation, the name and address of the registered agent for service of process of the corporation, and the names and addresses of the officers and directors of the corporation, and the names and addresses of any persons holding fifty percent (50%) or more of the stock of the corporation; if the applicant is a partnership, the application shall specify the name and address of the partnership, the name and address of all general partners of the partnership; if the partnership is a limited partnership, the application shall specify the name and address of all general partners who have a controlling interest in the partnership:

Name of Corporation:___________________________________________________________
Address of Corporation:___________________________________________________________
Phone Number of Corporation:___________________________________________________________
Date of Corporation:_____________________________________________________
State Incorporated In:____________________________________________________
Registered Agent for service of process of the corporation:_______________________

Names of all officers and directors of the corporation:

1)_______________________________ 4)________________________
2)_______________________________ 5)________________________
3)_______________________________ 6)________________________

Addresses of all officers and directors of the corporation:

1)_______________________________ 4)_________________________
2)_______________________________ 5)_________________________
3)_______________________________ 6)_________________________

Name of all persons holding 50% or more of the stock of the corporation:

1)_______________________________ 4)__________________________
2)_______________________________ 5)__________________________
3)_______________________________ 6)__________________________

Addresses of all persons holding 50% or more of the stock of the corporation:
1)_______________________________ 4)__________________________
2)_______________________________ 5)__________________________
3)_______________________________ 6)__________________________

Name of partnership:

Name of all general partners of the partnership:

1)_______________________________ 4)__________________________
2)_______________________________ 5)__________________________
3)_______________________________ 6)__________________________

Address of all general partners of the partnership:

1)_______________________________ 4)__________________________
2)_______________________________ 5)__________________________
3)_______________________________ 6)__________________________

If limited partnership:
Name of all general partners who have a controlling interest in the partnership:

1)_______________________________ 4)__________________________
2)_______________________________ 5)__________________________
3)_______________________________ 6)__________________________

Address of all general partners who have a controlling interest in the partnership:
1)_______________________________ 4)__________________________
2)_______________________________ 5)__________________________
3)_______________________________ 6)__________________________

(8)A license fee of five hundred dollars ($500) shall be submitted with the application for a license.

(9) I have read and am familiar with the provisions of this part and am in compliance with them. I Certify under oath that this application contains true information to the best of my knowledge and belief. I am aware of my continuing obligation to amend or supplement this application promptly if a change in circumstances affects the responses provided in this application, either before or after a licenses has been issued. I certify that I am knowledgeable of the laws pertaining to the operation of an adult oriented business.

Signature:_________________________________________ Date:___________

(10) Failure or refusal of the applicant to give any information relevant to the investigation of the application or the applicant's refusal or failure to appear at any reasonable time and place for examination under oath regarding the application or the applicant's refusal to submit to or cooperate with any investigation required by this part constitutes an admission by the applicant that the applicant is ineligible for such license and shall be grounds for denial thereof by the board.

No adult-oriented establishment shall open to do business before eight o'clock a.m. (8:00 a.m.), Monday through Saturday; and no such establishment shall remain open after 12:00 a.m. (midnight), Monday through Saturday. No adult-oriented establishment shall be open for business on any Sunday or a legal holiday as designated in TCA 15-1-101.

The opening and closing time limitations placed on adult-oriented establishments in Loudon County shall not apply to an establishment or the portion thereof which offers only live, stage adult entertainment in a theater, adult cabaret, or dinner show type setting.