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Affiliation Agreement DLC 4255 - Ohio

Affiliation Agreement Form. This is a Ohio form and can be used in Division Of Liquor Control Department Of Commerce Statewide .
 Fillable pdf Last Modified 9/3/2013
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Ohio Department of Commerce State of Ohio Division of Liquor Control 6606 Tussing Road Reynoldsburg, OH 43068-9005 (614) 644-2431 FAX (614) 644-3166 http://www.com.ohio.gov/liqr AFFILIATION AGREEMENT THIS FORM WILL BE RETURNED IF IT IS NOT COMPLETED ENTIRELY, AND SIGNED BY BOTH THE HOTEL OFFICER AND PERMIT HOLDER. This is to certify that (HOTEL) , are affiliated. (PERMIT HOLDER) and The (PERMIT HOLDER) will serve liquor to the hotel guests upon request during all hours of legal operation. Furthermore, (HOTEL) approves the affiliation agreement, in terms of processing the D5A liquor license. However the will assume all liability. (PERMIT HOLDER) HOTEL OFFICER SIGNATURE: _____________________________________ ________________________________ (SIGNATURE (TITLE) ______________ (DATE) PERMIT HOLDER SIGNATURE: _____________________________________ ________________________________ (SIGNATURE (TITLE) ______________ (DATE) DLC4255 EOE/ADA PROVIDER FOR TTY USERS DIAL ORS 1-800-750-0750 REV. 4/2012 American LegalNet, Inc. www.FormsWorkFlow.com
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