Alaska > Statewide > Alcoholic Beverage Control Board
Statement Of Financial Interest - Alaska
| Statement Of Financial Interest Form. This is a Alaska form and can be used in Alcoholic Beverage Control Board Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
STATE OF ALASKA ALCOHOLIC BEVERAGE CONTROL BOARD STATEMENT OF FINANCIAL INTEREST CONFIDENTIAL TO BE COMPLETED BY EACH APPLICANT, EITHER INDIVIDUAL OR CORPORATE AS 04.11.450(a) states that no person other than a licensee may have a direct or indirect financial interest in the business for which the license is issued. Applicant: DBA: EIN: Location: List each owner, shareholder, member in the boxes below: List below persons, firms, lending institutions or corporations which have or may have any financial involvement in furthering purchases of assets, revenues or operating capital for the licensed business operations. PLEASE CHECK THE FOLLOWING BOX IF NO INSTITUTIONS. NONE NAME ADDRESS AMOUNT PURPOSE Under the penalties of perjury, I declare that I have examined this application, including accompanying schedules and statements, and to the best of my knowledge and belief it is true, correct, and complete. Signature of Applicant/Transferee Subscribed and sworn to before me this Day of 20 Date Notary Public in and for the State of Alaska My commission expires CONFIDENTIAL American LegalNet, Inc. www.FormsWorkFlow.com FIS (Revised 07/12)
|
|||||||
