Withdrawal Of Application {44166}

WITHDRAWAL OF APPLICATION State Form 44166 (R / 3-16) ALCOHOL AND TOBACCO COMMISSION FOR OFFICE USE ONLY Date received (month, day, year) Date processed (month, day, year) Type of permit for which applied Permit number Name of applicant Address of applicant (number and street) City or town State ZIP code County This is to certify that I, _______________________________________________________________________, wish to withdraw my Application for an Alcoholic Beverage Permit at _____________________________________________________________________ which is now on file at the Indiana Alcohol and Tobacco Commission office at Indianapolis, Indiana. * Signature of applicant Date signed (month, day, year) * Only a pending application may be withdrawn. Permits approved by the Alcohol and Tobacco Commission cannot be withdrawn. American LegalNet, Inc. www.FormsWorkFlow.com