Washington > Statewide > Liquor Control Board > Financial
Outline Of Costs LIQ 823 - Washington
| Outline Of Costs Form. This is a Washington form and can be used in Financial Liquor Control Board Statewide . |
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Licensing and Regulation Division PO Box 43098 Olympia WA 98504-3098 360/664-1600 FAX 360/753-2710 www.liq.wa.gov License No _________________________________ Trade Name ________________________________ UBI No _____________________________________ OUTLINE OF COSTS Please complete the Outline of Costs stating ALL FUNDS used for your current application. (If you are making a change to your current business that already has a liquor license, state only the funds needed for this change to your business.) REAL PROPERTY (land and building): Lease rental (one month + deposit, if any) OR Total purchase cost $________________ Business purchase cost (Purchase & Sale Agreement normally includes trade name, good will, equipment, inventory, corporate stock or LLC units $________________ Costs of opening a new business (equipment, furniture, inventory) $________________ OR COST TO CHANGE YOUR CURRENTLY LICENSED BUSINESS Remodeling/leasehold improvements/construction $________________ Miscellaneous fees (such as license/gambling, legal, architectural, $________________ health/city/county permits, opening and closing costs, working capital, etc.) GRAND TOTAL of costs $________________* * This total should equal the sum of ALL Source of Funds forms completed for this application CERTIFICATION I certify under penalty of perjury that all answers and statements are true, correct and complete. I understand that untruthful or misleading answers are cause for rejection of my application and/or revocation of any license granted. I hereby authorize investigation of my criminal history, financial records and other sources as necessary for licensing. PRINT NAME _______________________________________________________ SIGNATURE __________________________________________________________________ DATE __________________ (Sole proprietor, partner, corporate officer or limited liability company manager or member) LIQ 823 - 8/09 American LegalNet, Inc. www.FormsWorkFlow.com
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