Alcoholic Beverage Retailers Permit Transfer Application Page 4
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9IV.
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 stockholder must submit a
PERSONAL RECORD (Form 1001), a SUMMARY FINANCIAL STATEMENT
(Form 2007), and two properly executed fingerprint cards with a certified
check for $24.00 made payable to 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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