Application For Transfer In Corporate Name Of Alcoholic Beverage Retailers Permit Form printable pdf download

Application For Transfer In Corporate Name Of Alcoholic Beverage Retailers Permit Form

(REVISED)

PERMIT DEPT USE ONLY

AMT OF CHECK________

CHECK NUMBER_______

PERMIT NUMBER______

APPLICATION FOR TRANSFER IN CORPORATE NAME OF

ALCOHOLIC BEVERAGE RETAILERS PERMIT

I,_______________________________________________, doing business as

________________________________________________________________

ABC Permit No.________ and located at_______________________________

(Street)

hereby submit application for

_____________________________________________________,

(city)

(county)

a transfer in corporate name to: ______________________________________

Telephone Number

(business)________________ (home)_________________

II.

Does the applicant have, or has the applicant ever had, an interest in any

other alcoholic beverage retailer’s

permit?________ If "yes" explain fully:

__________________________________________________________

III.

Is the applicant indebted to the State of Mississippi for any taxes, fees or

payment of penalties imposed by law or by any rule or regulation of

the

Commission?________ If "yes" explain fully:_______________________

__________________________________________________________

IV.

List your Mississippi Sales Tax Number:___________________________

List the total amount of stock,________common and ________preferred,

and each officer, director, and majority stockholder below. Include a copy

of the amended charter and attach a list of stockholder, amount of

stock

owned, and their addresses to this application.

NAME

CORP. TITLE

ADDRESS

AMT. SHARES

___________________

_______________

__________________

______________

__________________

___________________

_______________

__________________

______________

__________________

___________________

_______________

__________________

______________

__________________

Application For Transfer In Corporate Name Of Alcoholic Beverage Retailers Permit Form

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