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Liquor Control Board Addendum - Non-Retail And Interstate Common Carrier Licenses LIQ 149-52 - Washington

Liquor Control Board Addendum - Non-Retail And Interstate Common Carrier Licenses Form. This is a Washington form and can be used in Applications Liquor Control Board Statewide .
 Fillable pdf Last Modified 4/2/2007
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UBI Liquor Control Board Licensing and Regulation PO Box 43098 Olympia WA 98504-3098 www.liq.wa.gov Fax: (360) 753-2710 Liquor Control Board Addendum Non-Retail & Interstate Common Carrier Licenses This form must accompany a Master Application from the Department of Licensing, Master License Service Questions? Please call the Liquor Control Board's customer service desk at (360) 664-1600 1. 2. 3. 4. Do you have any interest, financial or otherwise, in any Washington State liquor retailer?..................................................................................................... Do you hold any notes, mortgages, or other forms of obligation against any Washington State retail licensee?......................................................................... If married, are you or your spouse employed by any liquor retailer?........................ Are you assuming a business that has a current liquor license?.......................... If yes, present licensee's liquor license number and class of license 5. 6. Are you closing your business and moving to a new location?................................... Contact person for questions regarding application Mailing address Business Phone 7. ( ) Home Phone ( ) YES NO YES YES YES YES NO NO NO NO Is this premises located on: Tribal lands?............................................................................................................... If yes, name of tribe Federal lands?........................................................................................................... If yes, name of federal entity Port authority lands?.................................................................................................. If yes, name of port authority Automotive track?...................................................................................................... If yes, name of track Fairground property?................................................................................................ If yes, name of fair authority YES NO YES NO YES NO YES NO YES NO OVER LIQ 149-52 2/99 Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com 8. List all liquor operating business names (not brand names). Attach a separate sheet if needed. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. FOR INTERSTATE COMMON CARRIER LICENSEES: 9. A. B. Number of duplicate common carrier licenses requested Name(s) to appear on duplicate licenses (if different than name on original license) LIQ 149-52 2/99 Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com
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