Laserfiche WebLink
<br />DEPARTMENT OF LIQUOR CONTROL, COUNTY OF HAWAI’I <br />OFFICE USE ONLY <br />HILO LAGOON CENTRE, 101 AUPUNI STREET, UNIT 230,HILO, HAWAI'I 96720-4261 <br />50.00 <br />Filing Fee: $ <br />PHONE: (808) 961-8218 FAX: (808) 961-8684 E-Mail: cohdlc@co.hawaii.hi.us <br /> Check Cash <br />____________ ____________ <br />APPLICATION FOR TRANSFER OF LIQUOR LICENSE <br />Application No. <br />TO THE LIQUOR COMMISSION OF THE COUNTY OF HAWAI'I: <br />The undersigned hereby makes application for the following liquor license and makes the following statement: <br />CLASS: KIND: CATEGORY: <br />1.Name of the applicant (company) is: <br />2.Applicant will do business under the name of: <br />3.Applicant’s mailing address is: <br />Telephone: FAX: E-mail: <br />4.The premises is located at: <br /> T.M.K. <br />5.Applicant is a/an: whose principal(s) are: <br />(Individual, Corporation, Partnership, Limited Liability Company, Limited Partnership, Unincorporated Association) <br />NameTitle <br /> <br /> <br /> <br /> <br />6.That no other person other than the Applicant named herein shall have any interest in the business of license <br />affected by this application without prior approval of such interest by the Liquor Commission and that no liquor <br />license issued to Applicant has been revoked within the term of two years preceding the date of this application. <br />7.I hereby certify that the above named applicant, principals and/or persons holding 25% more of stock are <br />twenty-one years of age or older and have not been convicted of a felony. <br />Signature of Applicant <br />I / Wehereby consent to the application for the <br />Print Name <br />transfer of the liquor license. <br />Title <br />_________________________________________ <br />___________________________________ <br />Date <br />Signature of Transferor <br />STATE OF HAWAI’I ) <br /> ) SS: <br />COUNTY OF HAWAI’I ) <br />he/sheApplicant <br /> , being first duly sworn, deposes and says that is the <br />he/shehe/she <br />herein named; that isauthorized to and does make this verification for and on its behalf; that has read <br />the foregoing application; and that the statements therein set forth are true. <br /> <br />Signature of Applicant before Notary <br />Subscribed and sworn to before me <br />this day of , 20. Doc. Date: # Pages: <br />Name: Circuit <br />Notary Public (signature) <br /> Doc. Description <br /> <br />Notary Public (print name) <br />My commission expires. <br /> <br /> <br />Signature Date <br />NOTARY CERTIFICATION <br /> <br /> <br />The County of Hawai`i is an Equal Opportunity Provider and Employer <br />