Public Safety & Welfare Committee

City Of Verona PUBLIC SAFETY AND WELFARE COMMITTEE MONDAY, JUNE 22, 2020 AT 5:30 P.M. AGENDA Due to the COVID-19 pandemic, the Verona Public Safety and Welfare Committee will hold its meeting as a virtual meeting. The Public Safety and Welfare Committee will not meet at City Hall, 111 Lincoln Street. Members of the Public Safety and Welfare Committee and Staff will join the meeting by using Zoom Webinar, as described immediately below. Members of the public can join the meeting using Zoom Webinar via a computer, tablet, or smartphone, or by calling into the meeting using phones, as described immediately below. Those requiring toll-free options are asked to contact City Hall for details prior to the meeting at adam.sayre@ci.verona.wi.us or 608-848-9941. Join the meeting via computer, tablet, or smart phone: https://zoom.us/j/94768049910 Webinar ID: 947 6804 9910 Join the meeting via phone by dialing: 312-626-6799 Webinar ID: 947 6804 9910 The online meeting agenda and all support materials can be found at https://www.ci.verona.wi.us/. In addition to the public, all Committee members and Staff will also be participating remotely. Anyone with questions prior to the meeting may contact the City at (608) 848-9941 or adam.sayre@ci.verona.wi.us. 1. Call to order 2. Roll Call 3. Approval of Minutes from the June 8, 2020 Public Safety and Welfare Committee meeting 4. Discussion and Possible Action Re: An application for a Class “B” Fermented Malt Beverages license from Hop Haus Brewing Company, 231 S. Main Street, Verona, WI 53593, Philipp Hoechst, Agent 5. Discussion and Possible Action Re: An application for a Combination Class “A” Fermented Malt Beverages and “Class A” Intoxicating Liquor license for Kwik Trip, Inc., d/b/a Kwik Trip #1075, 233 Wildcat Way, Verona, WI 53593, Juan Alfonso Primo, Agent 6. Discussion and Possible Action Re: An application for a Cigarette and Tobacco Products Retail License for Kwik Trip, Inc., d/b/a Kwik Trip #1075, 233 Wildcat Way, Verona, WI 53593  7. Discussion and Possible Action Re: A temporary premises description amendment for Tavern and Bar, LLC d/b/a Cahoots, 102 W. Railroad Street, Verona, WI 53593 8. Discussion and Possible Action Re: A temporary premises description amendment for LBO, Inc., d/b/a 5th Quarter, 161 Horizon Drive, #110, Verona, WI 53593 9. Adjournment Heather Reekie, Chairperson POSTED: Verona City Hall Miller & Sons Market City Web Page at: www.ci.verona.wi.us IF YOU NEED AN INTERPRETER, MATERIALS IN ALTERNATIVE FORMATS OR OTHER ACCOMODATION TO ACCESS THE MEETING, PLEASE CONTACT THE CITY CLERK AT 608-845-6495 AT LEAST 48 HOURS PRECEDING THE MEETING. EVERY REASONABLE EFFORT WILL BE MADE TO ACCOMMODATE YOUR REQUEST.  CITY OF VERONA PUBLIC SAFETY AND WELFARE COMMITTEE JUNE 8, 2020 VERONA CITY HALL MINUTES 1. Call to order: Heather Reekie called the meeting to order at 6:00 p.m. 2. Roll Call: Heather Reekie, Katie Kohl and Evan Touchett were present. Also present: City Administrator Adam Sayre, Police Chief Bernie Coughlin and City Clerk Ellen Clark. 3. Approval of Minutes: Motion by Kohl, seconded by Touchett, to approve the minutes from the May 26, 2020 Public Safety and Welfare Committee meeting. Motion carried 3-0. 4. Discussion and Possible Action Re: An application for a combination Reserve “Class B” Intoxicating Liquor and Class “B” Fermented Malt Beverages license from Mr. Brews Taphouse Verona, LLC, d/b/a Mr. Brews Taphouse, 611 Hometown Circle, Suite 104, Verona, WI 53593, Ryan Swanson, Agent. Mr. Brews Taphouse, LLC currently carries Class “B” Fermented Malt Beverage and Class “C” Wine licenses. If this application is approved, the Class “C” Wine license will be replaced by a “Class B” Intoxicating Liquor license, which will allow for the service of any intoxicating liquor, versus wine only. The current licenses will be surrendered to the City before the new licenses will be issued. Motion by Reekie, seconded by Touchett, to recommend to the Common Council to approve a combination Reserve “Class B” Intoxicating Liquor and Class “B” Fermented Malt Beverages license for Mr. Brews Taphouse Verona, LLC, d/b/a Mr. Brews Taphouse, 611 Hometown Circle, Suite 104, Verona, WI 53593, Ryan Swanson, Agent. Motion carried 3-0. 5. Discussion and Possible Action Re: A temporary premises description amendment for the liquor license of Toot & Kate’s LLC, d/b/a Toot & Kate’s Wine Bar, 109 S. Main Street, to include the front stoop area. Toot & Kate’s LLC has applied for a temporary premises description amendment to include the business’s front stoop area. This will allow them to serve more customers, while adhering to required social distancing guidelines. Coughlin stated the business owners are requesting one table on the right and two tables on the left side of the entrance to 109 S. Main Street, as well as a table on each side of the front step on the sidewalk. In most cases we would require a gate and signage indicating where alcohol consumption is permissible. In this case, signage is not necessary. The first two tables would be on the right and the left of the entrance to the business. They are also requesting a third table to the north in front of the window or 107 S. Main Street. The owner of 107 S. Main Street provided permission for them to place a tablethere. The issue is that the service of alcohol must be viewed and monitored. This area cannot be seen from inside the wine bar. If the bartender would have to be diligent watching the table. Just north of that table, there should be some separation so people cannot enter from the 107 S. Main business or stoop. Two tables are also being requested below the stoop. If these tables are placed in the terrace, they will be right next to the street. If they are placed on the sidewalk, the sidewalk will be obstructed, forcing walkers to walk in the terrace. He does not recommend approval of the third table to the north on the stoop, or the tables on the sidewalk, though the third table on the stoop is possible, with modifications. Touchett stated he is not in favor of tables on the sidewalk. He would be in favor of three tables on the stoop.  Coughlin replied the two or three tables on the stoop are a reasonable compromise. In addition, traffic noise gets sandwiched between the buildings, and makes it hard to have a conversation. We do want to work with them as much as possible, considering the COVID situation. Kohl asked if they could have some tables on the sidewalk later in the day when there is less traffic. Coughlin replied we need to be fair and consistent, with some guidelines that can be utilized for all businesses asking for premises amendments. If people are forced to walk on the terrace, there could be problems. Kohl stated you could not get around there with a stroller or a wheelchair. Reekie asked if they could use the alley to the south of the building. Sayre replied the owner of the alley will not allow it. Touchett does not think the sidewalk should be blocked in any way. He would like to use the stoop area, and allow three tables. Kohl stated forcing people to walk on the terrace is not ADA compliant, and the terrace is very close to the road. Touchett asked Coughlin if he would be comfortable with four tables on the stoop. Coughlin replied it would be preferable to using the sidewalk and the terrace. The challenge it creates is you would have a table north of the 107 S. Main business door, and the bartender cannot view that area for service, so they will not know who is consuming alcohol at that spot. Perhaps that could be done for a limited time only. Touchett would like to give them until October 1st, as was used for the Hop Haus. This is probably not an avenue for underage people to obtain drinks. Kohl stated the clientele there would be unlikely to be passing drinks to underage people. She would like to see four tables on the stoop until October 1 st. Motion by Touchett, seconded by Kohl, to recommend to the Common Council to approve a temporary premises description amendment for the liquor license of Toot & Kate’s LLC, 109 S. Main Street, to include the front stoop area only, with four tables for seating, restricted to 107 and 109 S. Main Street, until October 1, 2020. Motion carried 3-0. 6. Discussion and Possible Action Re: An amplification permit application from Hop Haus Brewing Company, LLC, 231 S. Main Street. Hop Haus Brewing Company, LLC is requesting an amplification permit to allow live music in the parking lot area of their premises, from 6 p.m. – 9 p.m. They anticipate this will take place two nights per week. Coughlin has no concerns with the request. Sara Hoechst asked permission to move the bands from the north side of the parking lot to the south side of the lot. There were no concerns with her request. Hoechst stated there will probably be bands only one night a week, as well as trivia on Tuesdays from 7-9 p.m. Motion by Kohl, seconded by Touchett , to approve an amplification permit application from Hop Haus Brewing Company, LLC, 231 S. Main Street. Motion carried 3-0. 7. Discussion and Possible Action Re: Approval of alcohol license applications for the 2020-2021 licensing period. Thirty-two applications for 2020-2021 retail alcohol license renewals were received by the City Clerk. Premises inspections by the building inspection and fire departments are ongoing, as they were delayed by COVID-19 restrictions. Approval of the applications will be contingent upon completion of building and fire inspections. A list of applicants is included in the Committee packet. Of those, the following has an unpaid invoice from the City for Police Department special event services in 2019:  n+1 Coffee and Beer Bar, 507 Bruce Street The alcohol license application for this applicant cannot be approved until the delinquent invoice has been paid in full. Motion by Reekie, seconded by Touchett , to recommend to the Common Council to approve alcohol license applications for the 2020-2021 licensing period, as presented by the City Clerk, contingent upon completion of building and fire inspections, and with the exception of n+1 Coffee and Beer Bar, 507 Bruce Street. Motion carried 3-0. Motion by Reekie, seconded by Touchett, to recommend to the Common Council to approve the alcohol license for n+1 Coffee and Beer Bar, 507 Bruce Street, contingent upon completion of building and fire inspections, and payment in full of unpaid invoices to the City. Motion carried 3-0. 8. Discussion and Possible Action Re: Approval of cigarette and tobacco products retail license applications for the 2020-2021 licensing period. Eight applications for 2020-2021 cigarette and tobacco products retail licenses were received by the City Clerk. The list of applicants is included in the Committee packet. Motion by Reekie, seconded by Kohl, to recommend to the Common Council to approve cigarette and tobacco products retail license applications for the 2020-2021 licensing period as presented by the City Clerk. Motion carried 3-0. 9. Discussion and Possible Action Re: Speed limit on Locust Drive. In February, 2020 Mayor Diaz and Common Council members received an email from some residents of Scenic Ridge and Cathedral Point regarding the speed limit on Locust Drive in those neighborhoods; particularly the intersections at Scenic Ridge Drive and Locust Drive, and Prairie Heights Drive and Locust Drive. They requested that the speed limit be lowered from 35 mph to 25 mph along this stretch of Locust Drive, as they believe drivers are exceeding the 35 mph speed limit, causing a safety issue. In response, Staff conducted a traffic study using a speed trailer on Locust Drive south of Highway 18/151 in May, 2020. Staff will share the study with the Committee and provide a recommendation. Chief Coughlin explained the data does not support a change in the speed limit in this area. Traffic studies were conducted from May 8th – May 12th. One was done with the display on, and another with the display off. The timing of the studies may not be ideal because of the pandemic. During this time frame, with the display on, 4,600 vehicles were monitored. Of those, 85% were traveling below 32 mph. Eight were traveling at speeds over 55 mph. These results are well within the range of tolerance. 5,200 vehicles were monitored with the display off. Of those, speed went down by one mile per hour, and only one drove over 55 mph. These numbers do not support a reduction in the speed limit, but that is the committee’s decision to make. In addition, the stretch of Locust south of Main Street and as far south of the bridge is more commercial, and a wider road. That section supports a 35 mph speed limit. In the residential area where the complaint was received, the road is narrower, and there is more pedestrian traffic. It can be difficult to cross from east to west. Nicole Osten joined the meeting. She agrees the timing of the study may be a factor, as she is seeing fewer cars. The neighborhood would like to see the limit lowered . A rapid rectangular flashing beacon may be a good solution, as well. She asked what the speed limit is on Cross Country Road. Coughlin replied Cross Country is the only 30 mph exception in the City. That was arrived at years ago. There have been no increased accident rates or safety issues because of the speed limit there. All other residential areas are 25 mph. Locust had always been seen as an extension of other roads; it is wider, and is in more of a commercial or industrial area. With the development of Scenic Ridge and Cathedral Point, reducing the speed limit is becoming more justified. If the Committee is considering reducing the speed limit, it should be reduced for the length of Locust from S. Main Street, south to the City limits to keep it consistent. Motion by Reekie, seconded by Kohl, to table this item until more information is available or another speed study can be done. Motion 3-0 10. Adjournment: Motion by Reekie, seconded by Kohl, to adjourn at 7:00 p.m. Motion carried 3-0. Ellen Clark, City Clerk  Auxiliary Questionnaire Alcohol Beverage License Application Submit to municipal clerk. Individual's Full Name (please print) (last name) (first name) (middle name) Zietlow Donald Paul I I Home Address (street/route) Post Office City State Zip Code 2802 Bergamot Pl. Onalaska WI 54650 Home Phone Number Age Date of Birth Place of Birth 608-779-0469 I 85 12/4/1934 Chaseburg, WI The above named individual provides the following information as a person who is (check one): D Applying for an alcohol beverage license as an individual. D A member of a partnership which is making application for an alcohol beverage license. � President of Kwik Trip, Inc. ""'-= """,... ,...""" ,.,. = ""' ""',... ,......,. --, (Nam-e-or c-o,-po-r ation-. "'"'umite""'d L�i a�b ility-C�o -m-p-an-y-or N-o-npro- fit O�rg_ a_n-iz atl_o n)--- - "" - --- ,... (Officer I Director I Member I M an ager I Agent) which is making application for an alcohol beverage license. The above named individual provides the following information to the licensing authority: 1. How long have you continuously resided in Wisconsin prior to this date? All my life. -------- - ---------- - - 2. Have you ever been convicted of any offenses (other than traffic unrelated to alcohol beverages) for violation of any federal laws, any Wisconsin laws, any laws of any other states or ordinances of any county or municipality? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Yes D No If yes, give law or ordinance violated, trial court, trial date and penalty imposed, and/or date, description and status of charges pending. (If more room is needed, continue on reverse side of this form.) Please see reverse. 3. Are charges for any offenses presently pending against you (other than traffic unrelated to alcohol beverages) for violation of any federal laws, any Wisconsin laws, any laws of other states or ordinances of any county or municipality? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes D 0 No If yes, describe status of charges pending. 4. Do you hold, are you making application for or are you an officer, director or agent of a corporation/nonprofit organization or member/manager/agent of a limited liability company holding or applying for any other alcohol beverage license or permit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � Yes D No If yes, identify. Officer of Kwik Trip, Inc. which holds multiple retail alcohol licenses 1n the State of VV1sconsin. (Name. Location and Type ofUc ensetPermitJ 5. Do you hold and/or are you an officer, director, stockholder, agent or employe of any person or corporation or member/manager/agent of a limited liability company holding or applying for a wholesale beer permit, brewery/winery permit or wholesale liquor, manufacturer or rectifier permit in the State of Wisconsin?. . . . . . . . . . D Yes 0 No If yes, identify. (Name of Wholesale Licensee o r Permittee) (Address ByCity andCounty) 6. Named individual must list in chronological order last two employers. Employer's Name Employer's Address Employed From To Kwik Trip, Inc. 1626 Oak St., La Crosse, WI 54603 9/1/1989 Present Employer's Name Employer's Address Employed From To Gateway Foods La Crosse, WI 1963 1989 READ CAREFULLY BEFORE SIGNING: Under penalty provided by law, the undersigned states that each of the above questions has been truthfully answered to the best of the knowledge of the signer. The signer agrees that he/she is the person named in the foregoing application; that the applicant has read and made a complete answer to each question, and that the answers in each instance are true and correct. The undersigned further understands that any license issued contrary to Chapter 125 of the Wisconsin Statutes shall be void, and under penalty of state law, the applicant may be prosecuted for submitting false statements and affidavits in connection with this applica­ tion. Any person who knowingly provides materially false information on this application may be required to forfeit not more than $1,000. ;()�_M;_ Donald P. AT-103 (R, 7-18) Wisconsin Department of Revenue  Auxiliary Questionnaire Alcohol Beverage License Application Submit to municipal clerk. I Individual's ,Full Name (please print) (las/name) (first name) (middle name) I Wrobel Jeffrey James Home Address (streellroute) Post Office City State Zip Code 3633 Bentwood Pl. La Crosse WI 54601 Home Phone Number Age Date of Birth Place of Birth ! 608-787-6596 59 7/16/1960 La Crosse, WI The above named individual provides the following information as a person who is (check one): D Applying for an alcohol beverage license as an individual. D A member of a partnership which is making application for an alcohol beverage license. � Treasurer of ____ K_w_ik_ Tr� i p�,..,.1.,,, nc_._-,,-......,.,-c-....,..,.,..,..,,,,.....,.........- -�---=--,:---,-....,....�--- /Officer I Director I Member I Manager I Agent) ,,,, (Name ,.... of Corporal/on. Um1ted Liability Company or f\/onprollt Organization) - which is making application for an alcohol beverage license. The above named individual provides the following information to the licensing authority: 1. How long have you continuously resided in Wisconsin prior to this date? -- - ------------------- All my life. 2. Have you ever been convicted of any offenses (other than traffic unrelated to alcohol beverages) for violation of any federal laws, any Wisconsin laws, any laws of any other states or ordinances of any county or municipality? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D Yes 0 No If yes, give law or ordinance violated, trial court, trial date and penalty imposed, and/or date, description and status of charges pending. (If more room is needed, continue on reverse side of this form.) 3. Are charges for any offenses presently pending against you (other than traffic unrelated to alcohol beverages) for violation of any federal laws, any Wisconsin laws, any laws of other states or ordinances of any county or municipality? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D Yes No 0 If yes, describe status of charges pending. -------------------------------- 4. Do you hold, are you making application for or are you an officer, director or agent of a corporation/nonprofit organization or member/manager/agent of a limited liability company holding or applying for any other alcohol beverage license or permit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Yes No D If yes, identify. Officer of Kwik Trip, Inc. which holds multiple retail alcohol licenses in the State of Wisconsin. (Name, Location and Type of Ucense!Permit) 5. Do you hold and/or are you an officer, director, stockholder, agent or employee of any person or corporation or member/manager/agent of a limited liability company holding or applying for a wholesale beer permit, brewery/winery permit or wholesale liquor, manufacturer or rectifier permit in the State of Wisconsin?. . . . . . . . . . D Yes � No If yes, identify. (Name of Wholesale Licensee or Permiltee) /Address By City and County) 6. Named individual must list in chronological order last two employers. Employer's Name Employer's Address Employed From To Kwik Trip, Inc. 1626 Oak St., La Crosse, WI 54603 6/1 /88 Present Employer's Name Employer's Address Employed From To Rau Corporation 600 Sumner St., La Crosse, WI 54603 1983 1988 READ CAREFULLY BEFORE SIGNING: Under penalty provided by law, the undersigned states that each of the above questions has been truthfully answered to the best of the knowledge of the signer. The signer agrees that he/she is the person named in the foregoing application; that the applicant has read and made a complete answer to each question, and that the answers in each instance are true and correct. The undersigned further understands that any license issued contrary to Chapter 125 of the Wisconsin Statutes shall be void, and under penalty of state law, the applicant may be prosecuted for subm itting false statements and affidavits in connection with this applica- 1;0,. Aay pecsoa who kaowiagly pcov;des mete,;,11y false ;,torrn,tioa oa th;s epplk,at;o $1,000. "iJi;;,;� "'iaiurooiNamed niiivto Jeffrey J. Wrobel AT-103 (R. 7-18) V\llsconsin Department of Revenue  Auxiliary Questionnaire Alcohol Beverage License Application Submit to municipal clerk. Individual's Full Name (please print) (last name) (first name) (middle name) A lfonso Primo Juan de Di os Home Address (street/route) Post Office City State Zip Code I l 9406 Ancien t Oak Ln. Ve rona WI 53593 Home Phone Number Age Date of Birth Place of Birth ' 608-669-7737 39 6/30/1980 Ci� �\Y1 .)..-\�.,,a(\ -dt!lh!IJ:11!!1 1 Me"ir::ol II :• The above named individual provides the following informa tion a s a person who is (check one): ., D App ying fo an a coho beverage li ense as an individual. l r l l c 5kb; \fev,?.cv-u 2:: D A member of a partnership h h s making app icat on fo an alcohol beverage l cen e. w ic i l i r i s C:u,.�:, \t\€1(1 C.0 IB] Agen t of Kwik Trip, Inc. ----- - N -am _ _ o _f�Co-r - o- a-ti-on- - m-, - (Officer I Director I M em b er I M anager I Agent) ( e p r . U te-· d_ Ll_ a__ b il-ity C_ _ o_m-pa_n y t 0-rg_a _n,-·,a-ti -on_) _____ _ _or _N _o -np -ro-fi- which is making application for an alcoho l beverage license. The above named individual provides the following information to the licensing au thority: 1. How long have you continuously resided in Wisconsin prior to this date? Since June 2007 ---------------------- Have you ever been convicted of any offenses (o ther than traffic unrelated to a lcohol beverages) for CJ i o e l l w , i cons s, o a t t r r s a c �r ����i;:��:/�� �� - � � - ��: _w � _ _ _ '.� :�� _ ��� :��� � �� -� ��� ��� �� -� - � �'.����� - �� �� _ ���? . . . . . D Yes �o If yes, give law or ordinance violated, trial court, trial da te and penalty imposed, and/or da te, descripti on and status of charges pending. (If more room is needed, continue on reverse side of this form.) (3\ Are charges for any offenses presently pending against you (other than traffic unrelated to alcohol beverages) U for vio ation of any f d ra a s, any W cons n a s, any a of o he states i l e e �f l l w · is · or o dinances of any oun y or i l w · · s· · ���d i ��: · · · · · · · · · · · · · · · · · · ·· ·· l ws t r ·· ·· ···················· · ······ r c t D Ye }:1' No ��:�� �:��r�b� -�t�i�s- cli�;ge s 4. Do you hold, are you making app lication for or are you an officer, director or agen t of a corpora tion/nonprofit organizati on or member/manager/agent of a limited liab ility company holding or applying for any other alcohol beverage li cense or permit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D Ye s [l?No If yes , ident ify. c tio_n _a -nd-= ------------------,,(N,.,.a-m-e,"""'-L o-a ""' - - o�fu - ce �� rm- �i )- ---------------- - -ns- e/P -rype e t 5. Do you hold and/or are you an officer, director, stockholder, agent or emp loyee of any person or corpora ti on or member/manager/agent of a li mi ted liab ility company holding or app lying for a wholesale beer permi t, brewery/winery permi t or wholesale liquor, manufacturer or rect ifier permi t in the State of W isconsin?. . . . . . . . . . D Yes _/ 116 No If yes, ident ify. ( Nam e of Wholesa le Licen s ee or Per m ittee) Cityand Count y) (Address By 6. Named individual must list in chronological order last two emp loyers. Employed From To 600 H ighland Ave ., Madison, WI 53792 3/12 4/14 Employers Name UWHC 1626 Oak S t ., La Crosse, WI 54603 12/12 Employed From To Kw ik Tri p, Inc. 11/10 Employer's Name READ CAREFULLY BEFORE SIGNING: Under penalty provided by law, the undersigned states tha t each of the above questions has been truthfully answered to the best of the knowledge of the signer. The signer agrees tha t he/she is the person named in the foregoing app lication; tha t the app lican t has read and made a comp lete answer to each ques tion, and that the answers in e ach instance are true and correct. The undersigned further understands tha t any license issued contrary to Chap ter 125 of the Wisconsin Sta tutes shall be void, and under penalty of state law, the applicant may be prosecuted for submitting false statements and affidavits �ction with this applica­ tion. Any person who knowingl y p rovides materia lly fa lse informa tion on this appl ication may be re uirecfto fodelf not more than $1,000. AT-103 (R. 7-18) Wsconsin Department of Revenue