Davenport, IA · Scott County
1,320-Foot Separation Certification
This certification is for the owner of a proposed business location to document its distance from certain existing Class E liquor license locations in or near downtown Davenport.
- licensed online notary
- ~15 min average
- Notarized PDF emailed
What you’ll need
- Government-issued photo ID
- Webcam-enabled device (laptop or phone)
- This form, ready to upload as a PDF
What this form is
This certification records the proposed business name and address, the owner’s name, and the applicant’s affirmation about the location’s distance from existing licensed locations. It states that the business is more than 1,320 feet from any location with a Class E carry-out liquor license in the past year within or adjacent to the area defined as Downtown Davenport. The owner-applicant completes it for the proposed business location as part of the city’s liquor license materials.
Who needs it
The owner-applicant for a proposed business location needs this form to certify the required separation from certain existing Class E carry-out liquor license locations.
Why it needs a notary
The form carries a signed-and-affirmed-before-me notarial block; the applicant signs the certification before the notary, who completes the block and applies a seal.
How to get this notarized
- 1
Download the Form
Get the 1,320-Foot Separation Certification from Davenport’s form page.
- 2
Fill In the Business Details
Enter the proposed business name and address, owner’s name, and other requested information.
- 3
Book an Online Notary
Arrange a session with a commissioned online notary before signing.
- 4
Sign on Video
Sign and affirm the certification during the online notarization session.
- 5
Submit It to the City
Send the completed, notarized form to Davenport with the applicable liquor license materials.
Preview the form
The blank PDF straight from Davenport. Look it over, then upload your filled copy to start the notary session.
You’ll need ID and a webcam.
A licensed online notary will join you on video, verify your government-issued ID, witness your signature, and apply their seal. You’ll receive the notarized PDF by email when the session ends.
Frequently asked questions
- How do I complete the separation certification?
- Enter the proposed business name and address and the owner’s name. The applicant signs the certification before a notary, then submits the completed form to the city with the liquor license materials.
- Do I need to sign this form in front of a notary?
- Yes. The form says the applicant’s certification must be signed and affirmed before a notary, and it includes space for the notary’s signature and seal.
- Can I use an online notary for this form?
- Iowa authorizes remote online notarization for its own notaries under Iowa Code §9B.14A. You may use a commissioned online notary; confirm with the city if unsure whether it will accept your notarized form.
- What distance does the certification cover?
- It certifies that the proposed location is more than 1,320 feet from a location with a Class E carry-out liquor license in the past year within or adjacent to Downtown Davenport, as defined on the form.