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Corporate Questionnaire ABC-243 - California

Corporate Questionnaire Form. This is a California form and can be used in Department Of Alcoholic Beverage Control Statewide .
 Fillable pdf Last Modified 1/10/2011
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Department of Alcoholic Beverage Control CORPORATE QUESTIONNAIRE State of California Edmund G. Brown Jr., Governor Instructions: Complete all items. One officer must sign for the corporation. Item 16 - List Certificates chronologically, including active, canceled, and pending issuance. If stock is pledged, include date, number of shares, and from whom to whom. 1. NAME OF CORPORATION 2. ABC LICENSE NUMBER 3. PREMISES ADDRESS 4. TELEPHONE NUMBER 5. ATTORNEY'S NAME 6. ATTORNEY'S TELEPHONE NUMBER 7. ATTORNEY'S ADDRESS 8. NAME OF BANK (Corporate account) 9. ACCOUNT NUMBER 10. ADDRESS OF CORPORATE BANK ACCOUNT 11. PERSONS AUTHORIZED TO SIGN ON BANK ACCOUNT (Print) 12. INCORPORATION DATE 13. STATE OF INCORPORATION 14. SECRETARY OF STATE FILE NUMBER 15. OFFICERS AND DIRECTORS TITLE NAME ADDRESS TELEPHONE NUMBER TITLE NAME ADDRESS TELEPHONE NUMBER TITLE NAME ADDRESS TELEPHONE NUMBER TITLE NAME ADDRESS TELEPHONE NUMBER TITLE NAME ADDRESS TELEPHONE NUMBER TITLE NAME ADDRESS TELEPHONE NUMBER 16. LIST ALL STOCK CERTIFICATES PERCENTAGE OF CERTIFICATE TO WHOM ISSUED NUMBER NUMBER OF SHARES OUTSTANDING SHARES OF STOCK DATE ISSUED DATE CANCELED Continued on reverse I hereby certify the above are the present officers, directors and/or stockholders and that each such officer, director and stockholder is the real party in interest with respect to his/her position and is not acting directly or indirectly as an agent, employee or representative of any other person not reported to the Department. The provisions of sections 23405 and 23405.3 of the Business and Professions Code are hereby acknowledged and it is understood that changes within the corporation and/or entities holding interest in the corporation will be reported to the Department as required. SIGNATURE (FOR THE CORPORATION) TITLE DATE SIGNED ABC-243 (rev. 01-11) American LegalNet, Inc. www.FormsWorkFlow.com LIST ALL STOCK CERTIFICATES (Continued from other side) PERCENTAGE OF CERTIFICATE TO WHOM ISSUED NUMBER NUMBER OF SHARES OUTSTANDING SHARES OF STOCK DATE ISSUED DATE CANCELED ABC-243 (rev. 01-11) American LegalNet, Inc. www.FormsWorkFlow.com
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