Davenport, IA · Scott County
Applicant’s Verification of 600-Foot Separation
This form lets a liquor license applicant verify that no listed child development home, child care center, or elementary or secondary school is within 600 feet of the business.
- 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 identifies the business and its owner, then certifies that no state-registered child development home, state-licensed child care center, or public or private elementary or secondary school is within 600 feet. The form describes measuring the distance in a straight line between the closest points of the relevant parcels. It is for the city’s liquor license process and includes a space for the applicant’s signature and notarial affirmation.
Who needs it
An owner applying for a liquor license for a Davenport business uses this form to make the required 600-foot separation certification.
Why it needs a notary
The form carries a signed-and-affirmed-before-me jurat; the applicant signs and affirms the certification before the notary.
How to get this notarized
- 1
Download the Form
Get the Applicant’s Verification of 600-Foot Separation form from the City of Davenport.
- 2
Complete the Applicant Details
Fill in the business name and address, owner name, and date. Review the 600-foot certification.
- 3
Book an Online Notary
Arrange a remote online notarization with a commissioned online notary.
- 4
Sign on Video
Sign and affirm the certification during the online notarization; the notary completes the notarial section.
- 5
Submit to the City
Submit the completed form to the City of Davenport as part of the liquor license process.
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
- Who signs the 600-foot separation verification?
- The applicant signs the certification as the owner of the named business. The form also asks for the applicant’s printed name and a notarial affirmation.
- How do I submit this form?
- Complete the business and owner information, sign and affirm the certification before a notary, then submit the form to the city as part of the liquor license process.
- Do I need to sign this form in front of a notary?
- Yes. The form includes a section stating that it was signed and affirmed before a notary public, with space for the notary’s signature and seal.
- Can I notarize this form online?
- Iowa authorizes remote online notarization by a commissioned online notary. Confirm with the city if unsure whether it accepts this form notarized remotely.