Questionnaire - Arizona Department Of Liquor Licenses And Control - 2015 Page 2
Download a blank fillable Questionnaire - Arizona Department Of Liquor Licenses And Control - 2015 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Questionnaire - Arizona Department Of Liquor Licenses And Control - 2015 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2If you checked the Manager box on the front of this form skip to # 15.
14. As a Controlling Person or Agent will you be physically present and operating the licensed premises? If you
Yes
No
answered YES, how many hrs/day? _______, and answer #14a below. If NO, skip to #15.
14a. Have you attended a DLLC-approved Liquor Law Training Course within the past 3 years?
Yes
No
(Must provide proof) If the answer to # 14a is “NO” course must be completed before issuance of a new license.
15. Have you been cited, arrested, indicted or summoned into court for violation of ANY law or ordinance,
Yes
No
regardless of the disposition, even if dismissed or expunged, within the past five (5) years? (For traffic violations,
only include those that were alcohol and/or drug related.)
16. Are there ANY administrative law citations, compliance actions or consents, criminal arrest, indictments
Yes
No
or summonses PENDING against you or ANY entity in which you are now involved? Include only criminal traffic
tickets and complaints.
17. Have you or any entity in which you have held ownership, been an officer, member, director or manager
Yes
No
had a business, professional or liquor application or license rejected, denied, revoked, suspended or fined in this
or any other state in the last 10 years?
18. Has anyone EVER filed suit or obtained a judgment against you, the subject of which involved
Yes
No
fraud or misrepresentation?
19. Are you NOW or have you EVER held ownership, been a controlling person, been an officer, member,
Yes
No
director or manager on any other liquor license in this or any other state?
If you answered “YES” to any Question 15 through 19 YOU MUST attach a signed statement.
Give complete details including dates, agencies involved and dispositions.
SUBSTANTIVE CHANGES TO THE APPLICATION WILL NOT BE ACCEPTED
20. I,
hereby declare that I am a CONTROLLING PERSON / AGENT / MANAGER
(Print Full Name) _______________________________________________,
Controlling Person / Agent / Manager
filing this notification. I have read this document and the contents and all statements are true, correct and complete.
X
State of ____________________County of ____________________
(Signature) ______________________________________________
this
Controlling Person / Agent
the foregoing instrument was acknowledged before me
____________ of ______________________ _____________
Day
Month
Year
My commission expires on:
___________________
___________________________________________________
Signature of NOTARY PUBLIC
COMPLETE THIS SECTION ONLY IF YOU ARE A CONTROLLING PERSON OR AGENT
APPROVING A MANAGER’S APPLICATION
21
. The applicant hereby authorizes the person named on t
his questionnaire to act as manager for the named liquor license.
The manager named must be at least 21 years of age.
_________________________________________________
(Print Name)
X
State of ____________________County of ____________________
(Signature) ______________________________________________
Controlling Person / Agent
the foregoing instrument was acknowledged before me this
__ __________ of ______________________ __________
___
Day
Month
Year
My commiss
ion
expires on:
__________________
____________________________________
______________
Signature of NOTARY PUBLIC
10/26/2015
Page 2 of 2
Individuals requiring ADA accommodations please call (602)542-9027
ADVERTISEMENT
0 votes
Related Articles
Related forms
License Application Instructions And Requirements - Arizona Department Of Liquor Licenses And Control
Legal
Instructions For Arizona Liquor License Renewal - Arizona Department Of Liquor Licenses And Control
Legal
Application For Out-of-state Producer Liquor Licenses- Arizona Department Of Liquor Licenses And Control
Legal
How To Read A Liquor License And What The Numbers Mean - Arizona Department Of Liquor Licenses And Control
Legal
Application For Growler Privileges With Series 12 Liquor License - Arizona Department Of Liquor Licenses And Control
Legal
Application For Liquor License Type Or Print With Black Ink - Arizona Department Of Liquor Licenses And Control
Legal
Related Categories
Parent category: Legal