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Waiver Of Operation Application - Alaska
| Waiver Of Operation Application Form. This is a Alaska form and can be used in Alcoholic Beverage Control Board Statewide . |
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Alcoholic Beverage Control Board 5848 E Tudor Rd Anchorage, Alaska 99507 (907) 269-0350 FAX (907) 272-9412 Waiver of Operation Application AS 04.11.330(a)(3) 15 AAC 104.170 License Information Liquor License Number: License Type: Local Governing Body: (City, Borough or Unorganized) Fees* Waiver Fee Penalty (If applicable) ________________ Total Submitted $ $ 1,000.00 ________________ $ Name of Licensee: Doing Business As (Business Name) Mailing Address: *The fee is non-refundable [15 AAC 104.170(c)] Telephone Number: Street Address or Location of Business City: Waiver Request Information This waiver application is the: Waiver Request for Calendar Year: 1st Request 2nd Request 3rd Request No Other _______ Is this license for sale? Yes Explanation of the circumstances for non-operation of license. Include relevant information as to why the license was not operated, any future plans for operating the license and projected timelines. Attach additional sheets if necessary. Signature of Licensee(s) Signature Name (Please Print) Date Signature Name (Please Print) Date WaiverApp 8/02 American LegalNet, Inc. www.FormsWorkflow.com
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