Application For Transfer In Officers/stock Of Alcoholic Beverage Retailers Permit printable pdf download

Application For Transfer In Officers/stock Of Alcoholic Beverage Retailers Permit

REVISED

PERMIT DEPT USE ONLY

(5/96)

AMT OF CHECK________

CHECK NUMBER_______

PERMIT NUMBER______

APPLICATION FOR TRANSFER IN OFFICERS/STOCK OF ALCOHOLIC

BEVERAGE RETAILERS PERMIT

I,__________________________________________,hereby submit application

(corporate officer’s name president/vice president)

for a transfer in officers of: __________________________________________

(corporate name)

_____________________________________________________________________________________________.

(doing business as)

Telephone Number

(business)______________________ (home)_________________________________

II.

Does the applicant have, or has the applicant ever had, an interest in any

other alcoholic beverage retailer’s permit?________ If "yes", explain fully:

__________________________________________________________

III.

Is the applicant indebted to the State of Mississippi for any taxes, fees or

payment of penalties imposed by law or by any rule or regulation of the

Commission?_________________ If "yes", explain fully:______________

__________________________________________________________

IV.

List your Mississippi Sales Tax Number:___________________________

STATEMENT OF OWNERSHIP

ALCOHOLIC BEVERAGE RETAILER PERMIT APPLICATION

List the amount of stock ,__________common and preferred, _________

and each officer, director, and majority stockholder below. Include a copy

of the corporate minutes showing this change along with a copy of the

stocks sold.

NAME

CORP. TITLE

ADDRESS

SHARES OWNED

____________________ _______________

__________________

_______________

__________________

____________________ _______________

__________________

_______________

__________________

____________________ _______________

__________________

_______________

__________________

____________________ _______________

__________________

_______________

__________________

(Note: Each officer*, director and the majority stockholder 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 ABC FF with this application.

A separate SUMMARY FINANCIAL STATEMENT must be completed for the corporation.

Application For Transfer In Officers/stock Of Alcoholic Beverage Retailers Permit

Related Articles

Related forms

Related Categories