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Get CA ABC-217 2019-2024

LANDLORD S NAME LANDLORD S ADDRESS 30. MONTHLY RENT 31. LEASE EXPIRATION DATE All ABC-217 rev. 11/11 32. State of California Edmund G* Brown Jr. Governor Department of Alcoholic Beverage Control APPLICATION QUESTIONNAIRE Please read instructions which includes Privacy Notice before completing form* 1. APPLICANT S NAME S If an individual first name middle name last name. Name of entity if corporation limited partnership or limited liability company. P-12 LICENSEE Yes No If yes complete form ABC-811 2. LICENSE TYPE S Check appropriate items 3. TRANSACTION TYPE Check appropriate item 20 Off-Sale Beer Wine 21 Off-Sale General 40 On-Sale Beer 47 On-Sale General Eating Place Other Original New Person-to-Person Transfer check appropriate section Section 24071 Surviving spouse corporations fiduciaries etc* Section 24071. 1 Corporate Stock/Limited Partnership Premises-to-Premises Transfer Exchange 4. TEMPORARY PERMIT REQUESTED Person-to-Person transfers only 5. PREMISES ADDRESS Where license to be issued Street number and name city zip code 6. PREMISES TELEPHONE NUMBER 7. PREMISES ARE INSIDE CITY LIMITS County 8. BUSINESS NAME DBA YOU WILL USE 9. BUSINESS MAILING ADDRESS Street number and name city state zip code 10. MAILING ADDRESS Permanent 11. ABC LICENSE COST Item 33a on reverse 13. HAS THE APPLICANT S EVER BEEN CONVICTED OF A FELONY Temporary 12. SUBTOTAL Item 33f on reverse OF THE DEPARTMENT PERTAINING TO THE ACT 15. IF YES TO ITEM 13 OR 14 PLEASE EXPLAIN 16. TRANSFEROR S NAME If an individual last first middle. Name of entity if corporation limited partnership or limited liability company. 17. ABC LICENSE NUMBER 19. PREMISES UNDER CONSTRUCTION IF YES LIST ESTIMATED COMPLETION DATE 20. FRANCHISE 21. NAME OF PERSON WE MAY CONTACT For the applicant 23. CONTACT TELEPHONE NUMBER 22. TITLE OF CONTACT PERSON 24. CONTACT E-MAIL ADDRESS 25. PREMISES IS CURRENTLY LICENSED IF YES TYPE OF LICENSE 26. CURRENT LICENSE IS OPERATING IF NO DATE CLOSED FINANCIAL INFORMATION 27. ESCROW COMPANY S NAME ESCROW COMPANY S ADDRESS TELEPHONE NUMBER 28. BOOKKEEPER/ACCOUNTANT S NAME BOOKKEEPER/ACCOUNTANT S ADDRESS 29. INDICATE WHETHER LEASE OR RENTAL AGREEMENT INCLUDES FURNITURE OR FIXTURES Some None COST 33. INVESTMENT INFORMATION a* ABC License b. Furniture/fixtures c* Inventory d. Goodwill/non-compete covenant e. Leasehold and/or Improvements f* SUBTOTAL Usually should equal the recorded notice g. Fees for other licenses permits and deposits approximate. Include Federal State County or City license fees or permits lease and utility deposits h. Working capital approximate i. Realty or interest therein j. TOTAL INVESTMENT Items f through i will equal total of amounts listed in item 33 34. Source of Funds for Total Investment item 33j - identify amount s type s and explain source s and/or terms of Repayment Amount 15 000 10 000 Type Gift Promissory Note Loan Source and/or Terms of Repayment John Doe Brother to seller payable 1 000 per month for 15 months from ABC Bank 8. 5 over 5 yrs monthly payment 2 052 35. LIST ALL BANK ACCOUNTS FOR THIS BUSINESS OPERATION BANK NAME BANK ADDRESS ACCOUNT NUMBER a* b.

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