Application For Liquor License Type Or Print With Black Ink - Arizona Department Of Liquor Licenses And Control Page 2
Download a blank fillable Application For Liquor License Type Or Print With Black Ink - Arizona Department Of Liquor Licenses And Control 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 Application For Liquor License Type Or Print With Black Ink - Arizona Department Of Liquor Licenses And Control 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
2
3
4
5
6SECTION 5 Interim Permit
If you intend to operate business while the application is pending, you will need an interim permit pursuant to A.R.S.§4-203.01.
For approval of an interim permit:
•
There must be a valid license of the same series issued to the current location you are applying for, OR
•
A Hotel/Motel license is being replaced with a restaurant license pursuant to A.R.S.§4-203.01(A)
1. Enter license number currently at the location: _________________________________________________________________
2. Is the license currently in use?
Yes
No
If no, how long has it been out of use? ______________________________
NOTARY
I
______________________________________________ hereby declare that I am the Agent, Current Owner, or
(Print Full Name)
Controlling Person on the stated license and location.
Signature: __________________________________________
State of _________________ County of _______________________
The foregoing instrument was acknowledged before me this
My Commission Expires on: __________________________
___________ Day of ___________________, ____________
Date
Day
Month
Year
___________________________________________________
Signature of Notary
SECTION 6 Background Check
EACH PERSON LISTED MUST SUBMIT A QUESTIONNAIRE, FINGERPRINT CARD, AND $22 PROCESSING FEE PER CARD.
1. If the applicant is an entity, and not an individual, answer questions 1a-b.
a) Date Incorporated/Organized: ___________________ State where Incorporated/Organized: _____________________
b) AZ Corporation or AZ L.L.C. File No: ___________________ Date authorized to do business in AZ: ___________________
2. List any individual or entity that owns a beneficial interest of 10% or more and/or controls the applicant or licensee. If
the applicant is owned by another entity, attach an organizational chart showing the ownership structure. Attach
additional sheets as needed. Disclose all controlling persons and members, shareholders or general partners who own a
beneficial interest of 10% or more of the applicant or licensee.
Last
First
Middle
Title
%Owned
Mailing Address
City
State
Zip
(Attach additional sheet if necessary)
SECTION 7 Probate, Receiver, Bankruptcy Trustee, Assignment, or Divorce Decree of an existing liquor license A.R.S.§4-204
EACH PERSON LISTED MUST SUBMIT A QUESTIONNAIRE, FINGERPRINT CARD, AND $22 PROCESSING FEE PER CARD.
1. Current Licensee’s Name: _________________________________________________________________________________________
(Exactly as it appears on the license)
Last
First
Middle
2.Assignee’s Name: _________________________________________________________________________________________________
Last
First
Middle
3.License Number: _________________________________________________
ATTACH A COPY OF THE DOCUMENT THAT SPECIFICALLY ASSIGNS THE LIQUOR LICENSE TO THE ASSIGNEE.
1/11/2018
page 2 of 6
Individuals requiring ADA accommodations please call (602)542-2999
ADVERTISEMENT
0 votes
Related Articles
Related forms
Application For Permit To Sell Salable Fireworks At Retail Form - Alaska Department Of Public Safety Division Of Fire Prevention
Legal
Application For A U.s. Passport Corrections, Name Change Within 1 Year Of Passport Issuance, And Limited Passport Holders
Life
Instructions For Completing The Cacfp Meal Benefit Income Eligibility Form - Arizona Department Of Education - 2018
Legal
Instructions For Completing The Cacfp Meal Benefit Income Eligibility Form - Arizona Department Of Education - 2018
Legal
Form Wv/mcr-1701 - Application For Motor Carrier Road Tax Transporter's Permit - West Virginia Department Of Tax And Revenue
Financial
Related Categories
Parent category: Legal