Alcoholic Beverage Retailers Permit Transfer Application
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9(Revised 7/96)
PERMIT DEPT. USE ONLY
AMT. OF CHECK________
CHECK NUMBER________
PERMIT NUMBER________
TRANSFER APPLICATION
ALCOHOLIC BEVERAGE RETAILERS PERMIT
I.
APPLICANT:________________________________________________
(name of sole owner, partnership, or corporation)
Trade Name ________________________________________________
Mailing Address ____________________________________________
(street/p.o.box)
(city)
(state)
(zip)
Location of business ________________________________________
(street)
(city)
(zip)
This location is ___ inside ___ outside the corporate city limits.
Include a copy of the lease or deed to the business premises and submit a new floor plan
of the premises if altering the floorplanned premises (see instructions).
Telephone Number
(business) ___________________ (home)_____________________
II.
TYPE OF ORGANIZATION
(
) sole ownership
(
) partnership
(
) corporation
(
) trust
(
) other _________________________________
III.
Does the applicant have, or has the applicant ever had, an interest in
any other alcoholic beverage retailers permit? ___________ If "yes",
explain fully: _______________________________________________
__________________________________________________________
IV.
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:
__________________________________________________________
_________________________________________________________
V.
List your Mississippi sales tax number:_________________________
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