HomeMy WebLinkAboutForm - Annual Listing of Persons in Active Charge of PremisesDEPARTMENT OF LIQUOR CONTROL COUNTY OF HAWAI‘I Hilo Lagoon Centre, 101 Aupuni Street, Unit 230, Hilo, Hawai‘i 96720 * Phone: (808) 961-8218 *
Fax: (808) 961-8684 * E-mail: cohdlc@hawaiicounty.gov
TO: LICENSEE(S)
RE: ANNUAL LISTING OF PERSONS IN ACTIVE CHARGE OF PREMISES
Pursuant to Rule 5-3 of the Rules and Regulations of the Liquor Commission of the Department of
Liquor Control of the County of Hawai‘i, State of Hawai‘i, please complete and return by __________
Alphabetically list the persons whom you have appointed to be in active charge of the premises
(“liquor card” holders). List their card numbers and expiration date, if available.
NAME (Last Name, First Name) CARD NO. EXPIRATION DATE (MM / YYYY)
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Licensee (DBA Name):
By:
(Signature)
Print Name:
Title:
Contact No:
E-mail: