Business Premises Surrender Form {LIC-4019-FORM}

LIC-4019-FORM - BUSINESS PREMISES SURRENDER FORM. This form is for Applicants and Licensees who need to remove a proposed or existing Business Premises location from their Application. This form must be submitted within ten (10) business days of the termination of a lease, termination of the right to occupy the Business Premises, and/or loss of site control. Once you have surrendered your previous Business Premises address, that location will no longer be included on DCR’s Licensing Map or considered for distancing purposes under Los Angeles Municipal Code (LAMC) section 105 et seq. Important: The submission of this form will permanently remove the Business Premises address from your Record, and it may not be reinstated. Submission of this form may have legal or business consequences depending on your lease agreements, prior business arrangements, and individual circumstances. It is recommended that you seek legal advice prior to the submission of this form. www.FormsWorkflow.com