Statement Of Legal Or Equitable Interest - Arizona Department Of Liquor Licenses And Control Page 2
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1
2LICENSEE DATA:
Licensee/Applicant’s Name: _______________________________________________________________________________________________
(Exactly as it appears on the license/application) Last
First
Middle
Owner Name: _____________________________________________________________________________________________________________
(Corporation, LLC, Partnership, etc.)
Mailing Address: ___________________________________________________________________________________________________________
Location Address: _________________________________________________________________________________________________________
(Exactly as it appears on the license)
License Number: ___________________________________________
Phone Number: __________________________________________
NOTARY
I, Print Name _____________________________________, have read this document and the contents and all statements
are true, correct and comp lete.
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
A.A.C. R-19-1-407
FILING OF LEGAL OR EQUITABLE INTEREST
A.
In accordance with A.R.S. Section 4-112.B.3, all persons having a legal or equitable interest in a spirituous liquor license shall file
with the director a statement of such interest on a form prescribed and furnished by the department. Notice of termination of
such interest shall be filed in writing by the interest holder upon final determination of the interest. Interest holders shall
immediately file amended statements to reflect any change in the current statements presently on file.
B.
The director may periodically, by notice to the holders of interests filed under this rule and under A.R.S. Section 4-112.B.3,
require such interest holders to verify in writing to the director that the statement presently on file is currently correct and
accurate and, if not, such interest holder shall immediately file an amended statement or termination notice. If no response is
received by the director within thirty (30) days of the mailing of such notice, the interest shall be deemed terminated.
C.
All persons having filed statements of interest in accordance with this rule and the statute shall be given notice of all matters
and/or actions affecting or regarding the spirituous liquor license in which they have an interest.
D.
Notice as required in C above shall be fully effective by mailing a copy thereof by registered or certified mail in a sealed
envelope with postage prepaid and addressed to such person at his address shown by the statement on file with the director.
Service of such notice shall be complete when deposited in the U.S. Mail.
E.
All interest holders who are entitled to receive notice as provided for herein above shall have the right to appear and
participate in person and through counsel in any hearing held before the board or director affecting the subject spirituous
liquor license as his interests may appear.
F.
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.
1/14/2016
Page 2 of 2
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