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Get CA ABC-521-1 2013-2024

Applicant acknowledges all provisions requirements and restrictions set forth in Form ABC-521 Priority License Instructions. I declare under penalty of perjury that the information provided on this form is true and correct and do hereby apply for a priority license as indicated above. Department of Alcoholic Beverage Control State of California PRIORITY LICENSE APPLICATION Instructions DATE Complete this form only after thoroughly reviewing ABC-521. 5. Applicant certifies that he/she has no interest in any other priority application for the same type of license on-sale off-sale and transaction original inter-county transfer in the same county and acknowledges that any changes in ownership or interest in the applicant entity made after the application is submitted may be grounds for disqualification from the priority licensing process. Use the reverse side if you need more space to disclose ownership information* Include a certified check cashier s check or money order for the application fee. LICENSE TRANSACTION ORIGINAL LICENSE TYPE INTERCOUNTY TRANSFER ON-SALE GENERAL RESTAURANT BAR CLUB COUNTY WHERE BUSINESS TO BE LOCATED APPLICANT S NAME Print MAILING ADDRESS Street number and name city state zip code PHONE NUMBER TYPE OF OWNERSHIP Check one Sole Owner Partnership Limited Partnership LP Corporation Limited Liability Company LLC Other LIST ALL OFFICERS DIRECTORS GENERAL PARTNERS if LP AND MANAGERS if LLC OF THE APPLICANT AND THEIR TITLES PRINTED NAME TITLE LIST ALL STOCKHOLDERS LIMITED PARTNERS OR LLC MEMBERS OF THE APPLICANT AND THEIR PERCENTAGE OF OWNERSHIP MUST TOTAL 100 1. 3. Applicant agrees that the Application for Alcoholic Beverage License Form ABC-211 will be submitted within ninety 90 days of notification of eligibility to file the formal application* The application will be made in the same name s as it appear s above. same type whether in active status or surrendered to the Department pursuant to Department Rule 65 and will not apply at any location actively licensed with the same type of license. APPLICANT SIGNATURE This form to be notarized if not signed in the presence of an ABC employee ABC-521-1 8/13 DATE EXECUTED. Use the reverse side if you need more space to disclose ownership information* Include a certified check cashier s check or money order for the application fee. LICENSE TRANSACTION ORIGINAL LICENSE TYPE INTERCOUNTY TRANSFER ON-SALE GENERAL RESTAURANT BAR CLUB COUNTY WHERE BUSINESS TO BE LOCATED APPLICANT S NAME Print MAILING ADDRESS Street number and name city state zip code PHONE NUMBER TYPE OF OWNERSHIP Check one Sole Owner Partnership Limited Partnership LP Corporation Limited Liability Company LLC Other LIST ALL OFFICERS DIRECTORS GENERAL PARTNERS if LP AND MANAGERS if LLC OF THE APPLICANT AND THEIR TITLES PRINTED NAME TITLE LIST ALL STOCKHOLDERS LIMITED PARTNERS OR LLC MEMBERS OF THE APPLICANT AND THEIR PERCENTAGE OF OWNERSHIP MUST TOTAL 100 1. 3. Applicant agrees that the Application for Alcoholic Beverage License Form ABC-211 will be submitted within ninety 90 days of notification of eligibility to file the formal application* The application will be made in the same name s as it appear s above. same type whether in active status or surrendered to the Department pursuant to Department Rule 65 and will not apply at any location actively licensed with the same type of license. .

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