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Application For Renewal Of Solicitor Registration DLC 1608 - Ohio

Application For Renewal Of Solicitor Registration Form. This is a Ohio form and can be used in Division Of Liquor Control Department Of Commerce Statewide .
 Fillable pdf Last Modified 8/8/2011
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APPLICATION FOR RENEWAL OF SOLICITOR REGISTRATION STATE OF OHIO DEPARTMENT OF COMMERCE DIVISION OF LIQUOR CONTROL BEER AND WINE SECTION 6606 TUSSING ROAD - P.O. BOX 4005 REYNOLDSBURG, OH 43068-9005 614-644-2411 INSTRUCTIONS: SECTION I TO BE COMPLETED BY THE EMPLOYER SECTION II TO BE COMPLETED BY THE EMPLOYEE A $50.00 FEE IS DUE WITH EACH RENEWAL APPLICATION. MAKE CHECKS PAYABLE TO "DIVISION OF LIQUOR CONTROL" SECTION I EMPLOYER INFORMATION - TO BE COMPLETED BY THE EMPLOYER EMPLOYER (company name): STREET ADDRESS: STATE: ZIP CODE: AREA CODE/ PHONE NUMBER: TITLE: CITY: PERMIT NUMBER: CONTACT PERSON: EMAIL ADDRESS: SWORN STATEMENT: I _____________________________________ , AM AN EMPLOYER OF THIS COMPANY AND STATE THE (EMPLOYER SIGNATURE) ABOVE INFORMATION IS TRUE AND CORRECT. SECTION II NAME: ADDRESS: CITY: EMPLOYEE / AGENT INFORMATION - TO BE COMPLETED BY THE EMPLOYEE / AGENT AREA CODE/ PHONE NUMBER: STATE: PLACE OF BIRTH: ZIP CODE: DATE OF BIRTH: EMAIL ADDRESS: Have you been convicted of any offense other than a minor traffic violation within the past two years? IF YES, a full explanation and copy of CERTIFIED Journal Entry, sentence or disposition MUST be attached. YES NO SWORN STATEMENT: I ___________________________________________________ , STATE THE ABOVE INFORMATION IS TRUE AND CORRECT. (EMPLOYEE SIGNATURE) FOR DIVISION USE ONLY ID# OTHER: Denied (Signature) DLC 1608 FOR TTY USERS DIAL 1-800 -750-0750 EOE/ADA SERVICE PROVIDER DATE ISSUED CHECK# AMOUNT$ Superintendent Approval/Denial: Approved (Date) REVISED 5/2011 American LegalNet, Inc. www.FormsWorkFlow.com
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