Davenport, IA · Scott County
600-Foot Separation Verification
This form lets a Davenport business owner certify that no specified school or child care provider is within 600 feet of the business for a liquor license application.
- 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
The applicant certifies that the business is not within 600 feet of a state-registered child development home, state-licensed child care center, or public or private elementary or secondary school. The form describes measuring the distance in a straight line between the closest points of the relevant parcels and cites Davenport Municipal Code Subsections 5.10.105(A) and (D). It is for the business owner to complete and affirm before a notary.
Who needs it
A business owner applying for a Davenport liquor license needs this form to certify the business’s distance from the listed schools and child care providers.
Why it needs a notary
The form has a signed-and-affirmed-before-me notary block; the applicant signs and affirms the certification before the notary.
How to get this notarized
- 1
Download the Form
Get the 600-Foot Separation Verification form from Davenport.
- 2
Fill In the Business Details
Enter the business name and address, owner name, and date, then complete the certification.
- 3
Book an Online Notary
Arrange a remote notarization with a commissioned online notary.
- 4
Sign on Video
Sign and affirm the certification before the notary during the online session.
- 5
Submit to the City
Submit the completed form with your Davenport liquor license application.
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 600-foot separation verification?
- Enter the business and owner details, certify the required distance from the listed properties, then sign and affirm before a notary.
- Do I need to sign this form before a notary?
- Yes. The form includes a signed-and-affirmed-before-me notary block for the applicant’s certification.
- Can I use an online notary for this form?
- Iowa authorizes remote online notarization for its notaries under Iowa Code §9B.14A. A commissioned online notary can witness your signing by video.
- Where do I submit the completed form?
- The form is for a Davenport liquor license application. Ask the city how to submit it with your application; confirm with the city if unsure.