Form Il 567-0015-A - Application For State Of Illinois Distributor/ Importing Distributor/foreign Importer Liquor License Page 5

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MISCELLANEOUS INFORMATION

WAREHOUSING

If any of your inventory is warehoused, provide the name, street address, city, state, Zip Code and county of the warehouse. NOTE: Warehouse

inspection will be conducted prior to the issuance of your liquor license.

ADDRESS

CITY

COUNTY

STATE

ZIP CODE

LEASED PREMISES

If you lease your premises, the lease must cover the full term of the license. If you lease, provide the landlord’s name, telephone number, street

address, city, state, Zip Code and county.

LANDLORD NAME

AREA CODE/TELEPHONE NO.

CITY

STATE

ZIP CODE

COUNTY

ADDRESS

5. LICENSE HISTORY

FIRST LICENSE APPLICATION - LICENSE HISTORY

Indicate by checking the correct box whether or not this is the corporation’s, sole proprietorship’s, etc’s first application for a State liquor license

at any premises. If you check “no”, indicate the date of your first State liquor license application. Also indicate whether the license was granted,

denied or withdrawn. Provide the address of your first State liquor license application. If you have ever had a license application denied or if you

ever withdrew an application, please provide a written statement describing the reason and circumstances.

IS THIS YOUR FIRST STATE LICENSE APPLICATION?

YES

IF NO, PROVIDE DATE FIRST APPLIED:

†

WITHDRAWN

DISPOSITION:

GRANTED

DENIED

ADDRESS OF FIRST STATE APPLICATION: