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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 TRANSFER OF STOCK <br /> <br />Name of Corporation dba License No. <br /> <br />Licensee or Authorized Representative Phone Fax <br /> <br />Address of Licensee or Authorized Representative E-Mail <br /> <br />Date of Incorporation State of Incorporation Date Registered, DCCA, State of Hawai‘i <br /> <br />ORIGINAL STOCK DISTRIBUTION SHARES HELD PERCENTAGE <br />STOCKHOLDER <br /> <br />PROPOSED STOCK TRANSFER SHARES HELD PERCENTAGE <br />STOCKHOLDER* <br /> <br />PROPOSED OFFICERS AND DIRECTORS <br />(All officers and directors shall file a personal history form) <br /> <br />PROPOSED DATE OF TRANSFER OF STOCK <br />SPECIAL INSTRUCTIONS: Indicate the name, address, telephone and facsimile for the following: <br />A.Notice of hearings. <br />B.Service of process (within State of Hawai‘i). <br />C.Department of Liquor communications. <br />D.License renewal. <br />E.Financial reports. <br />SUBMIT:Stock Purchase Offer. <br /> Minutes of Election of Officers, when applicable. <br /> Personal History Forms. <br /> Official Notice of closing of stock purchase and copies of the stock certificate(s). <br />I hereby certify that there have been no changes in officers, directors, or stockholders except as authorized <br />by the Liquor Commission and that each such officer, director or stockholder is thereal party in interest <br />of the corporation. <br />Authorized Signatory: Print Name: <br />Title: Date: <br />Date of Liquor Commission Approval: <br />*Transfer of 25% or more, or person becomes owner of 25% of stock, file personal history form. <br />Hawai‘i County is an Equal Opportunity Provider and Employer <br />