Application For Change Of LLC Membership Interests {DLC 4259}

APPLICATION PROCESS Ohio Department of Commerce Division of Liquor Control 6606 Tussing Road Reynoldsburg, OH 43068 614-644-2360 The Division of Liquor Control ("Division") has outlined the application process below in an effort to avoid your application being returned. Therefore it will be necessary for you to submit all the documents on the "REQUIRED DOCUMENTS FOR ACCEPTANCE" sheet. If your application is filed without all of those documents, the application will not be accepted and will be returned to you. Once your application is received, provided all required documents are submitted, the following process begins: 1. 2. The Division logs your application into a computerized system for processing. The Division will send an Official Notice to the legislative authority of the municipality/township it is located in (city council or township trustees and county commissioners). Note: Any of these entities have the right to object to your application, provided they do so within 30 days of that notification. The Division also sends a separate notice to the local law enforcement agency for informational purposes as required by law and to work in conjunction with the Legislative Authority should they desire to object to the issuance of your permit. The Division will work with your County Board of Elections to determine the wet/dry status of your proposed permit premises. Note: This information is not needed on applications for transfer of ownership. The Division will send the Personal History Background Form(s) you provided to the law enforcement agency in the municipality or township of your permit premises in order to have a separate background check conducted with them. The Division works with the Ohio Bureau of Investigation ("BCI") to have conducted a required background check on all persons involved in your business. In order for the Division and BCI to conduct this background check, you are required to provide the Division with the proper documentation and information so that a background check can be performed. Please see DLC 4191 to determine whether you or persons involved in your business should submit a completed paper fingerprint card or be fingerprinted electronically via a "WebCheck" system. A Division Compliance Officer will contact you to set up an appointment to conduct an initial inspection of your premises. At the time your inspection is completed our compliance officer will survey the area surrounding the proposed permit premises to determine if there are any institutions such as schools, churches, libraries, public playgrounds, or township parks within 500 feet. By law, any of these institutions can object to the issuance of your permit within 30 days of notification. If the business is not in operation or the premises did not meet all requirements at the initial inspection, a final inspection will need to be conducted at a later date. Please allow two weeks when notifying the Division for a final inspection. Your C or D class permit certificate is issued for a permit period that expires on February 1, June 1 or October 1, depending on the county where your permit is located, and is renewed annually on that date. Renewal dates by county may be found by visiting http://www.com.ohio.gov/liqr/docs/LIQR_RenewalDistricts.pdf . All A, B, H or G Class permits renew annually on October 1. If you have applied for a New Retail permit (NOT a Transfer), and it is issued within six months of the expiration date, you will receive a 50% refund of the class fee(s) paid. NOTE: The $100.00 processing fee is non-refundable. 3. 4. 5. 6. 7. 8. It is our goal to process your application in a timely and efficient manner. Many factors determine the length of time it takes to complete the process of your application, therefore your assistance in providing us with a complete application packet will help us in accomplishing our goal. Rev. 04/14/2014 FOR TTY USERS DIAL 1-800-750-0750 - EOE/ADA SERVICE PROVIDER American LegalNet, Inc. www.FormsWorkFlow.com Office Hours 8:00 a.m. - 5:00 p.m. For Questions call (614) 644-3156 APPLICATION FOR CHANGE OF LLC MEMBERSHIP INTERESTS PROCESSING FEE $100.00 CAUTION: ALLOW 10 TO 12 WEEKS FOR PROCESSING PERMIT HOLDER REQUESTS APPROVAL OF THE DIVISION OF LIQUOR CONTROL OF THE FOLLOWING: Ohio Department of Commerce - Division of Liquor Control 6606 Tussing Road, Reynoldsburg, Ohio 43068-9005 http://www.com.ohio.gov/liqr Permit Holder Name: Liquor Permit Number(s): Federal Tax ID Number: Permit Premises Address: Email Address: Attorney's Name, Address and Telephone Number (If represented): Please be advised that any social security numbers provided to the Division of Liquor Control in this application may be released to the Ohio Department of Public Safety, the Ohio Department of Taxation, the Ohio Attorney General, or to any other state or local law enforcement agency if the agency requests the social security number to conduct an investigation, implement an enforcement action, or collect taxes. Section A - PREVIOUS List of managing members and all persons with a 5% or greater membership or voting interest in the LLC NAME 1) PLEASE COMPLETE ALL AREAS OF SECTION A & B BELOW SOCIAL SECURITY # OR FEDERAL TAX ID # OFFICE HELD INTEREST Managing Member Voting interest Membership interest % % BIRTHDATE 2) Managing Member Voting interest Membership interest % % 3) Managing Member Voting interest Membership interest % % % % 4) Managing Member Voting interest Membership interest Section B - REVISED List of managing members and all persons with a 5% or greater membership or voting interest in the LLC NAME 1) SOCIAL SECURITY # OR FEDERAL TAX ID # OFFICE HELD INTEREST Managing Member Voting interest Membership interest % % % % % % % % BIRTHDATE 2) Managing Member Voting interest Membership interest Managing Member 3) Voting interest Membership interest Managing Member 4) Voting interest Membership interest DLC4259 EOE/ADA SERVICE PROVIDER FOR TTY USERS DIAL ORS 1-800-750-0750 Revised 6/2013 American LegalNet, Inc. www.FormsWorkFlow.com THE FOLLOWING MUST BE COMPLETED BY AN INDIVIDUAL WHO HAS A 5% OR MORE MEMBERSHIP INTEREST LISTED IN SECTION B, ON PAGE 1 1. Do you or any office holder, managing member owning 5% or more of either the voting interest or membership interests of the LLC, spouse, or other person involved in this permit have a financial interest in another permit business? If YES, Give permit number & address on the line provided ________________________