Affidavit And Application, Class Ii Temporary Permit Form
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2AFFIDAVIT and APPLICATION, CLASS II TEMPORARY PERMIT
AFFIDAVIT AUTHORIZING TRANSFER
I, _________________________________________ , doing business as
____________________________________ , ABC Permit No. _____________
hereby authorize the Alcoholic Beverage Control to issue a Class II Temporary
Retailers Permit to _________________________________________________
doing business as _________________________________________________
effective ___________________________________ .
________________________________
(present owner’s signature)
APPLICATION FOR CLASS II TEMPORARY PERMIT
I.
APPLICANT: _______________________________________________
(name of sole owner, partnership, or corporation)
ADDRESS: __________________________________________
(street/post office box)
(city)
(state)
(zip)
II.
BUSINESS: ________________________________________________
(trade name)
ADDRESS: ___________________________________________
(street)
(city)
(zip)
COUNTY: ____________ TELEPHONE No. (b.) _____________
(h.) ____________
III.
TYPE OF APPLICANT ENTITY:
(
) Sole Owner
(
) Partnership
___________________
(
) Trust
(
) Corporation (
) Other
IV.
Have you or any member of your partnership or association, or any
officer, director, or majority stockholder of your corporation, ever been
convicted of any of the following: a felony regardless of its nature in any
state or federal court, a violation of the Local Option Alcoholic Beverage
Control Laws, or violation of any other law relating to alcoholic beverages,
beer or light wine? ______________ If "yes", explain fully: _________
__________________________________________________________
__________________________________________________________
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