Application For Liquor License Type Or Print With Black Ink - Arizona Department Of Liquor Licenses And Control Page 3
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6SECTION 8 Government (for Cities, Towns or Counties only)
Government Entity: ______________________________________________________________________________________
1.
2. Person/Designee: ________________________________________________________________________________________
Last
First
Middle
Daytime Contact Phone #
SECTION 9 Person to Person Transfer ARS§4-203(C), (D), (G)
(Bar and Liquor Stores only – Series 06, 07, and 09)
1. License #: __________________________________________
2. Individual Owner/Agent Name: ___________________________________________________________________________________
Last
First
Middle
3. Ownership Name: _________________________________________________________________________________________________
(Exactly as it appears on the license)
4. Current Business Name: ____________________________________________________________________________________________
(Exactly as it appears on the license)
5. Business Location Address: _________________________________________________________________________________________
Street
City
State
County
Zip
6. Current Daytime Phone: ____________________________ Primary Email Address: _________________________________________
7. Does current licensee intend to operate the business while this application is pending?
Yes
No
8. I, (
: ____________________________________________________ authorize the transfer of this license to the applicant.
Signature)
NOTARY
I
______________________________________________ hereby declare that I am the Individual Agent, Owner,
(Print Full Name)
Or 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 10 Location Transfer– Current Licensee Information ARS§4-203(C), (D), (G)
(Bar and Liquor Stores only – Series 06, 07, and 09)
1.Current Business:
Name: ___________________________________________________________________________
Address: _________________________________________________________________________
(exactly as it appears on license)
2.New Business:
Name: ___________________________________________________________________________
Address: _________________________________________________________________________
1/11/2018
page 3 of 6
Individuals requiring ADA accommodations please call (602)542-2999
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