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Business Packet For Reporting Changes L-BRC - Texas
| Business Packet For Reporting Changes Form. This is a Texas form and can be used in Alcoholic Beverage Commission Statewide . |
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Business Packet for Reporting Changes L-BRC (8/2012) The Business Packet for Reporting Changes is to be used to report any changes to your current business structure. You must complete the entire Business Packet for Reporting Changes including all ownership information. Personal history sheets (PHS) must be submitted on individuals as required that are new to your entity. See the application guidelines for information on submitting PHS. This packet includes L-BRC and the below entity pages that coincide with your business structure. · L-C (Corporation, Trust, City, County or University) · L-P (Partnership) · L-LLC (Limited Liability Company) · L-40.2 (Personal History Sheet) INDICATE ALL CHANGE(S) YOU ARE REPORTING WITH THIS APPLICATION 1. Current License/Permit No. 2. Type of Change Officer, Manager, Director, Stockholder, Member Partner (limited or general) Trustee/Beneficiary Change of Business Entity Merger Conversion Consolidation (Package Store Only) Other 3. Are you applying for a change of class? If "YES," indicate type of change: Yes No FROM Wine and Beer Retailer's Permit (BG) TO Wine and Beer Retailer's Off-Premise Permit (BQ) FROM Beer Retailer's On-Premise License (BE) TO Beer Retailer's Off-Premise License (BF) OWNER INFORMATION 4. Owner of Business on Current License/Permit 5. Federal Employer Identification No. (FEIN) OWNER INFORMATION (ONLY FOR CHANGE OF BUSINESS ENTITY, MERGER, AND CONVERSION) 6. Type of Owner Individual Corporation Limited Liability Company Partnership Limited Partnership Limited Liability Partnership Trust Joint Venture City/County/University Other 7. Effective Date of Change (mm/dd/yyyy) / / BUSINESS INFORMATION 8. Has any person listed in this Business Packet, or his or her spouse, been finally convicted or received deferred adjudication for any of the following offenses? Yes No If "YES," indicate type of offense and attach an explanation: any felony offense prostitution bookmaking gambling or gaming bootlegging vagrancy offense involving moral turpitude any offense involving dangerous drugs or controlled substances as defined in Texas Controlled Substances Act any offense involving firearms or a deadly weapon more than three violations of the Texas Alcoholic Beverage Code relating to minors violations of the Texas Alcoholic Beverage Code resulting in a criminal fine of $500 violations of an individual's civil rights or discrimination against an individual on the basis or race, color, creed or national origin If "YES," has it been five years since the termination of a sentence, parole or probation served for any offenses indicated above? Yes No If "NO," attach an explanation. 9. Has any person listed in this Business Packet, or his or her spouse, had a cancellation of a license or permit in the past five years? Yes No If "YES," attach an explanation. Page 1 of 2 Form L-BRC American LegalNet, Inc. www.FormsWorkFlow.com The applicant or license/permit holder may have an interest, directly or indirectly, in only one level of the alcoholic beverage industry; i.e., manufacturing, wholesaling or retailing. You or your agent, servant or employee may not be employed in any capacity at different levels, may not rent or lease property or equipment from or to an entity operating at another level, may not secure credit or a loan in any form for an entity at another level, cannot control in any fashion the interests of a licensee/permittee at a different level. 10. Is any person listed in this Business Packet, or in the ownership of this permit/license, in violation of the above requirements? Yes No If "YES," attach an explanation. COMPTROLLER OF PUBLIC ACCOUNTS CERTIFICATE (FOR CHANGE OF ENTITY ONLY) This is to certify on this day of , 20 , the applicant holds or has applied for and satisfies all legal requirements for the issuance of a Sales Tax Permit under the Limited Sales, Excise and Use Tax Act or the applicant as of this date is not required to hold a Sales Tax Permit. Sales Tax Permit Number Print Name of Comptroller Employee Print Title of Comptroller Employee SIGN HERE FIELD OFFICE Outlet Number SEAL WARNING AND SIGNATURE If Applicant Is/Must Sign Individual/Individual Owner Partnership/Partner Limited Partnership/General Partner Corporation/Officer Limited Liability Company/ Officer or Manager EACH LICENSEE OR PERMITTEE SHALL HAVE EXCLUSIVE OCCUPANCY AND CONTROL OF THE ENTIRE LICENSED LOCATION WITH RESPECT TO SALE OF ALCOHOLIC BEVERAGES. ANY ARRANGEMENT THAT SURRENDERS SUCH CONTROL OF THE EMPLOYEES, PREMISES OR BUSINESS, INCLUDING PROFITS AND LOSSES, TO PERSONS OTHER THAN THE LICENSEE OR PERMITTEE IS UNLAWFUL. WARNING: Section 101.69 of the Texas Alcoholic Beverage Code states: "...a person who makes a false statement or false representation in an application for a permit or license or in a statement, report, or other instrument to be filed with the Commission and required to be sworn commits an offense punishable by imprisonment in the penitentiary for not less than 2 nor more than 10 years." BY SIGNING YOU ARE SWEARING TO ALL INFORMATION AND ATTACHMENTS TO THIS PACKET. PRINT NAME SIGN HERE TITLE Before me, the undersigned authority, on this day of , 20 , the person whose name is signed to the foregoing application personally appeared and, duly sworn by me, states under oath that he or she has read the said application and that all the facts therein set forth are true and correct. SIGN HERE NOTARY PUBLIC SEAL Page 2 of 2 Form L-BRC American LegalNet, Inc. www.FormsWorkFlow.com
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