Form Dbpr Abt-6035 - Application For Transfer Of Ownership Of An Alcoholic Beverage License Page 2
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15SECTION 3 – LICENSE INFORMATION
If the applicant is a corporation or other legal entity, enter the name as registered with the Secretary of State
on the line below.
Full Name of Applicant
Corporate Document # __________________________
Trade Name (D/B/A)
FEIN Number or Social Security Number*
Business Telephone Number
Location Address (Street and Number)
City
County
State
Zip Code
Mailing Address (Street or P.O. Box)
City
State
Zip Code
Resident Agent/ Contact Person
Phone Number
Street Address
City
State
Zip Code
Current Business Name
Current License Number
If this application is for the transfer of this license, is the transfer due to revocation proceedings?
Yes
No
If yes, is there any personal relationship to the transferor?
Yes
No
If yes, explain the relationship:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
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Parent category: Legal