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<br />DEPARTMENT OF LIQUOR CONTROL COUNTY OF HAWAI‘I <br />Hilo Lagoon Centre, 101 Aupuni St., Unit 230, Hilo, Hawai‘i 96720 * Phone: (808)961-8218 * Fax: (808)961-8684 <br />E-Mail: cohdlc@co.hawaii.hi.us <br />APPLICATION FOR DUPLICATE LIQUORLICENSE <br />TO THE LIQUOR COMMISSION OF THE COUNTY OF HAWAI‘I: <br /> The undersigned hereby applies for a duplicate liquor license to replace the following: <br />License No. Effective Date <br /> (Give the number and effective date of the license which has been lost) <br />Class Kind <br /> (Dispenser, Retail, etc.) (General, Beer and Wine, Beer) <br />Issued to <br /> (Name of Licensee) <br />Doing business as <br />For the premises located at <br /> (Street address or location of business) <br />The licensee for which this duplicate is asked was lost or destroyed in the matter <br />indicated below and is no longer in the possession of the licensee. (State as accurately as <br />possible the manner in which the license was lost or destroyed and date of occurrence.) <br /> <br /> <br /> <br />The undersigned certifies that this application for a duplicate of the above described <br />license is made in good faith and that every statement contained herein is true, unless stated on <br />information and belief, and in such case the statements are believed to be true. Further, the <br />undersigned agrees to return to the commission, if found, the original license which was believed <br />to have been lost or destroyed. <br />Licensee: <br />By <br /> (Signature) <br />Name: <br />Title: <br />Date: <br />Phone No.: <br />E-Mail: <br />Hawai‘i County is an Equal Opportunity Provider and Employer <br /> <br />