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Request For Amendment To Origianl Documents LIC1024 - Arizona

Request For Amendment To Origianl Documents Form. This is a Arizona form and can be used in Liquor Licenses And Control Statewide .
 Fillable pdf Last Modified 4/26/2011
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ARIZONA DEPARTMENT OF LIQUOR LICENSES & CONTROL 800 W Washington 5th Floor Phoenix AZ 85007-2934 (602) 542-5141 REQUEST FOR AMENDMENT TO ORIGINAL DOCUMENT(S) YOU MUST SUPPLY THE INFORMATION FOR THE ITEM(S) SPECIFIED BELOW ON THE AMENDMENT SHEET(S) PROVIDED. THESE AMENDMENTS ARE REQUIRED BY THE DEPARTMENT BEFORE YOUR APPLICATION OR DOCUMENT(S) ARE CONSIDERED COMPLETE. 1. COMPLETE THE ITEM(S) SPECIFIED BELOW ON THE AMENDMENT SHEET(S) PROVIDED, 2. COMPLETE THE SIGNATURE BLOCK BELOW AND HAVE YOUR SIGNATURE NOTARIZED, AND 3. RETURN BOTH THE AMENDMENT PAGE(S) AND THIS PAGE TO THE DEPARTMENT. LIQUOR LICENSE # _________________________________ ITEMS TO BE COMPLETED ON THE AMENDMENT PAGE(S) (TYPE OR PRINT WITH BLACK INK): I, ________________________________________________ , declare that: (Print name of APPLICANT/AGENT) 1) I am the APPLICANT ling this amendment. 2) I have read the amendment and the content and all statements are true, correct and complete. State of __________________ County of ___________________ X_________________________________________________ (Signature) The foregoing instrument was acknowledged before me this ___________________day of _______________________, ___________ Day Month Year My commission expires on: LIC 1024 5/2009 ___________________________________________ (Signature of NOTARY PUBLIC) American LegalNet, Inc.
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