Certificate Of Good Standing Application For A Liquor License Transfer Form printable pdf download

State of Rhode Island and Providence Plantations

Department of Revenue

Division of Taxation

One Capitol Hill

Providence, Rhode Island 02908-5812

Telephone Number: 401-574-8829 #2

Certificate of Good Standing Application for a Liquor License Transfer

Taxpayer Name: _____________________________________________________________________________

DBA: ______________________________________________________________________________

Address: _____________________________________________________________________________

City, State,

Zip Code: ______________________________________________________________________________

Location:

__________________________________________________________

A certificate of good standing is required for you to transfer your liquor license. Since these requests are processed on a first

come, first serve basis, failure to complete the application properly could result in delays, which are unnecessary. Please return

this application promptly in the pre-addressed envelope provided.

Note: Any outstanding taxes must be paid by Certified check, Money Order or Cash prior to

issuance of Certificate

Complete All of the Following:

Application Date: ____________________________ Federal ID_________________________________________

Business Type: Sole Owner____ Corporation______ Partnership _______ Other ___________________________

Do you have employees? Yes_____ No ______ Federal ID #: __________________________________________

Do you lease employees? Yes _____ No ______ Name of Company______________________________________

SS Number(s) of Owner/Partners: _________________________________________________________________

Telephone Number(s): Home _______________________ Business _____________________________________

Print Name of Responsible Person ________________________________________________________________

Signature of Responsible Person _________________________________________________________________

Office Use Only

Sales and Use Tax Del_____________________________A/R_________________________________________

Local Meal/Beverage Tax: _________________________A/R_________________________________________

Withholding Tax Del______________________________A/R_________________________________

Personal Income Tax______________________________A/R_________________________________

Corporate Tax Del________________________________A/R_________________________________

Litter___________ Sales Renewal____________ Cig____________Hotel____________Ret CK_______________

DET: __________________Remarks_____________________________________________________________

Revenue Officer_____________________________________________ Date____________________________

Clearance Authorized By:______________________________________________________________________

Certificate Of Good Standing Application For A Liquor License Transfer Form