New Alcoholic Beverage Retailers Permit Application Page 5
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13III.
Will this business be operated as a partnership? ___________ If "yes",
list each partner’s name and extent of his interest in the partnership.
NAME
HOME ADDRESS
AMT. OF INTEREST
OWNED
______________
_________________________ ________________
______________
_________________________ ________________
______________
_________________________ ________________
Note: Each partner must submit a PERSONAL RECORD (Form 1001), a SUMMARY
FINANCIAL STATEMENT (Form 2007), and two (2) properly executed fingerprint cards
with a certified check for $24.00 made payable to the ABC FF with this application. A
separate SUMMARY FINANCIAL STATEMENT (Form 2007) must be completed for the
partnership. Include a copy of your partnership agreement.
IV.
Will this business be operated as a corporation? ____________ If
"yes", list the total amount of stock, ________________________
common and ______________________ preferred, and each officer,
director, and majority stockholder below. Include a copy of the corporate
charter and attach a list of all stockholders, amount of stock owned, and
their addresses to this application.
NAME
CORP. TITLE
ADDRESS
SHARES OWNED
______________________ __________ _________________ __________
_________________
______________________ __________ __________________ __________
__________________
______________________ __________ __________________ _________
__________________
______________________ __________ __________________ _________
__________________
Note: Each officer*, director, and the majority stockowner must submit a PERSONAL
RECORD (Form 1001), a SUMMARY FINANCIAL STATEMENT (Form 2007), and two
(2) properly executed fingerprint cards with a certified check for $24.00 made payable to
the ABC FF with this application. A separate SUMMARY FINANCIAL STATEMENT
(Form 2007) must be completed for the corporation. *Officers owning less than 5% of
the stock of the corporation do not file a Summary Financial Statement.
V.
Will this business be operated as a trust? _____________ If "yes", list
the trustee and each beneficiary below.
NAME
TYPE
STATE OF RESIDENCY
__________________________ _______________ ____________________
__________________________ _______________ ____________________
__________________________ _______________ ____________________
Note: The trustee and each beneficiary must submit a PERSONAL RECORD (Form
1001) with this application (a SUMMARY FINANCIAL STATEMENT is not required).
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