Statement Of Legal Or Equitable Interest - Arizona Department Of Liquor Licenses And Control
Download a blank fillable Statement Of Legal Or Equitable Interest - 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 Statement Of Legal Or Equitable Interest - 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
2Arizona Department of Liquor Licenses and Control
800 W Washington 5th Floor
Phoenix, AZ 85007-2934
(602) 542-5141
STATEMENT OF LEGAL OR EQUITABLE INTEREST
NOTE:
This document must be signed by both the licensee and the interest holder. Filing this form with the License and
Control does not create a lien. This form is for notification purposes only.
Information provided on this form is NOT to be relied upon for determining the ownership of a license. This form’s purpose is
only to give the Arizona Department of Liquor notice of interests, and to entitle the interest holder to certain notices
regarding Arizona Department of Liquor disciplinary actions.
INTEREST HOLDER DATA:
Interest Holder’s Name: ________________________________________________________________________________________________
Last
First
Middle
Mailing Address: _______________________________________________________________________________________________________
Street
City
State
Zip
Business Phone: ________________________________________ Daytime Contact Number: _____________________________________
Email Address: _________________________________________________________________________________________________________
The licensee or prospective licensee, hereby grants to the above named interest holder, a legal and/or equitable interest in the
designated spirituous liquor license, pursuant to and in accordance with that certain ___________________________________________,
(Describe document that generated this interest, i.e. security agreement, etc.)
hereinafter called Collateral Agreement, between the licensee and the interest holder, said is dated:____/____/____ and which
Collateral is incorporated herein by reference. An executed copy of the Collateral Agreement will be located and
_____________________________________________________________________________
available for inspection and reproduction at:
(Insert business name and address where Collateral Agreement is located)
This statement is filed in accordance with A.R.S. §4-112.B(3) and A.A.C. R19-1-407. The statement of legal or equitable interest shall
allow the person filing said statement to participate in the proceedings and shall not in any manner bind the Director or the State
Liquor Board concerning the matter under consideration. The parties acknowledge and agree that all notices will be made with
the parties at the addresses shown herein above, unless same are changed in writing and delivered to the Department of Liquor
Licenses and Control.
NOTARY
I, Print Name_____________________________________, have read this document and the contents and all statements
are true, correct and complete.
X
_____________________
State of _____________________County of
The foregoing instrument was acknowledged before me this
________________________
____________ of __________________, ___________
My commission expires on:
Day
Month
Year
_________________________________________________________________________________
Signature of NOTARY PUBLIC
1/14/2016
Page 1 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
Farm Winery Fair/festival License Application - Arizona Department Of Liquor Licenses And Control
Legal
Craft Distiller Fair/festival License Application - Arizona Department Of Liquor Licenses And Control
Legal
Unlicensed Business Establishment Application For Exemption - Arizona Department Of Liquor Licenses And Control
Legal
Request For Notice Of Disciplinary Hearing - 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