Form Dbpr Abt-6036 - Division Of Alcoholic Beverages And Tobacco Election Of Surcharge Calculation Method And Inventory Report Form Page 4
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4SECTION 4 – LICENSE TRANSFERS ONLY
Former Applicant Name
Business Name
Alcoholic Beverage License Number
Series
Former Owner Certifies that the
Purchases Method
Sales Method
was used to calculate the beverage surcharge and that all surcharges have been paid as of ____________.
Date
New owner and former owner certify that the following inventory is being transferred for consumption on the
premises:
(Enter Number Here)
Gallons of Draft Beer
Gallons of Packaged Beer
Gallons of Coolers
Gallons of Cider
Gallons of Wine
Gallons of Liquor
FORMER AND NEW OWNER SIGNATURES
___________________________________________________________________
__________
Signature of Former Owner
Date
___________________________________________________________________
__________
Signature of New Owner/Applicant
Date
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