Authorization For Release Of Financial Information And Statement Of Personal History

DCPLC-Pers Hist - AUTHORIZATION FOR RELEASE OF FINANCIAL INFORMATION & STATEMENT OF PERSONAL HISTORY. This form is used by the State of Connecticut’s Department of Consumer Protection, Liquor Control Division, as part of the liquor permit application process. It must be completed by the permittee as well as each backer, member, or partner associated with the permit. The form collects essential personal and business information such as name, contact details, relationship to the liquor permit, percentage of ownership, aliases, and date of birth. It also requires disclosure of any public offices held and any prior felony convictions, which, if applicable, must be further detailed using a supplemental worksheet. Most importantly, this form serves as a legal authorization for the Department to conduct a comprehensive background check. By signing it, the applicant consents to the release of their criminal, employment, financial, and credit history by relevant agencies and institutions to determine their suitability to hold or back a liquor permit. The form must be signed under penalty of law, affirming the accuracy and completeness of the information provided. www.FormsWorkflow.com