Corporate Information Addendum - Washington State Liquor ...



UBI FORMTEXT ?????Licensing and RegulationPO Box 43098, 1025 Union Ave SEOlympia WA 98504-3098lcb.Phone – (360) 664-1600 Fax – (360) 753-2710Liquor and Cannabis Board Addendum - RetailThis form must accompany a Business License Application from the Department of Revenue, Business Licensing ServiceQuestions? Please call the Liquor and Cannabis Board’s customer service desk at (360) 664-1600FOR ALL APPLICANTS:1.Applicant name FORMTEXT ?????2.Are you assuming a business that has a current liquor license? FORMCHECKBOX YES FORMCHECKBOX NOIf yes, current licensee’s liquor license number and class of license FORMTEXT ?????3.Are you closing your business and moving to a new location? FORMCHECKBOX YES FORMCHECKBOX NOAddress of new location FORMTEXT ?????4.Contact person for questions regarding application FORMTEXT ?????Mailing address FORMTEXT ?????Business Phone( FORMTEXT ?????) FORMTEXT ?????Home Phone( FORMTEXT ?????) FORMTEXT ?????5.Is this premises location on:Tribal lands? FORMCHECKBOX YES FORMCHECKBOX NOIf yes, name of tribe FORMTEXT ?????Federal lands? FORMCHECKBOX YES FORMCHECKBOX NOIf yes, name of federal entity FORMTEXT ?????Port authority lands? FORMCHECKBOX YES FORMCHECKBOX NOIf yes, name of port authority FORMTEXT ?????Automotive track? FORMCHECKBOX YES FORMCHECKBOX NOIf yes, name of track FORMTEXT ?????Fairground property? FORMCHECKBOX YES FORMCHECKBOX NOIf yes, name of fair authority FORMTEXT ?????OVER6.Does any applicant or spouse have any interest, financial or otherwise, in any manufacturer, distributor, or importer of beer, wine, or spirits? FORMCHECKBOX YES FORMCHECKBOX NO7.Does a manufacturer, distributor, or importer of beer, wine, or spirits have any interest in your business, financial or otherwise? FORMCHECKBOX YES FORMCHECKBOX NO8.Is any applicant or spouse employed by a manufacturer, distributor, or importer of beer, wine, or spirits? FORMCHECKBOX YES FORMCHECKBOX NO9.For sole proprietorship or partnership applications: Have the sole proprietor and spouse or each partner and spouse resided in Washington State at least one month prior to filing this application? FORMCHECKBOX YES FORMCHECKBOX NOFOR SPIRITS, BEER, AND WINE RESTAURANTS SEASONAL LOCATIONS:1.If this is a declared seasonal operation, check the calendar quarters during which you will operate: FORMCHECKBOX January - February - March FORMCHECKBOX July - August - September FORMCHECKBOX April - May - June FORMCHECKBOX October - November - DecemberFOR SPIRITS, BEER, AND WINE RESTAURANT DUPLICATE LICENSES:1.For Spirits, Beer, and Wine restaurants who plan to sell liquor from additional sites on the same property, and are applying to operate within an: FORMCHECKBOX Airport Terminal FORMCHECKBOX Civic Center FORMCHECKBOX Privately owned facility open to the public, which contains multiple buildings with separate dining facilities.2.How many duplicate licenses do you want? FORMTEXT ????(Please see the “Liquor License Fee Information and Description Sheet” for fees) ................
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