Form At-112 - Application For Transfer Of Licenses For Sale Of Fermented Malt Beverages And/or Intoxicating Liquor From One Premises To Another - Wisconsin Department Of Revenue Page 2
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1
2ALL APPLICANTS FOR TRANSFER OF CLASS B LICENSES MUST ANSWER THE FOLLOWING:
3.
If granted, state any interest, directly or indirectly, that any brewer, bottler, wholesaler, manufacturer, or
rectifier will hold in the premises for which you are applying
4.
If you do not own the fixtures, state the manner, terms and conditions under which said fixtures are held
(Signature)
}
State of Wisconsin
ss.
County of
(I) (We),
and
being first duly sworn on oath says that (he/she is) (they are) the person(s) above named and that the answers
to the questions in each instance are complete and true.
Subscribed and sworn to before me this
day of
, 20
Notary Public,
County, Wis.
My Commission Expires
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