Business Data Report - Arizona Department Of Liquor Licenses And Control
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1Arizona Department of Liquor Licenses and Control 800
W Washington 5th Floor
Phoenix, AZ 85007-2934
(602) 542-5141
BUSINESS DATA REPORT
THIS FORM IS REQUIRED TO RENEW SERIES 11 AND 12 LICENSES WHICH HAVE BEEN IN OPERATION FOR A
PERIOD OF TWELVE MONTHS OR LONGER.
Licensee’s Name:
D.B.A.:
License #:
Percentage of revenue from food sales
Time Period included in this report:
/
/
through
/
/
Month Day Year
Month Day Year
SALES INFORMATION
(Please report your sales for the reporting period that includes the 12 months preceding your license expiration date)
MONTH/YEAR
FOOD SALES
TOTAL LIQUOR SALES
TOTAL SALES
0
0
0
0
0
0
0
0
0
0
0
0
TOTALS
0
0
0
INVENTORY VALUE (most recent)
FOOD
BEER
WINE
LIQUOR
TOTAL
(exclude non- food items)
0
DOLLAR AMOUNT
I certify that all information presented on this report is true and accurate:
Signature:
Title:
Date:
/
/
03/15/2017
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Individuals requiring ADA accommodations please call (602)542-9027
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