HomeMy WebLinkAboutForm - Application for Transfer of Membership Interest (fillable)DEPARTMENT OF LIQUOR CONTROL COUNTY OF HAWAI‘I Hilo Lagoon Centre, 101 Aupuni St., Unit 230, Hilo, Hawai‘i 96720 * Phone: (808)961-8218 * Fax: (808)961-8684 E-Mail: cohdlc@co.hawaii.hi.us
Hawai‘i County is an Equal Opportunity Provider and Employer
APPLICATION FOR TRANSFER OF MEMBERSHIP INTEREST
Name of Limited Liability Company dba License No.
Licensee or Authorized Representative Address Phone Fax
Date of Organization State of Organization Date Registered, DCCA, State of Hawai‘i
ORIGINAL MEMBER MEMBERSHIP PERCENTAGE
INTEREST HELD
PROPOSED MEMBER MEMBERSHIP PERCENTAGE INTEREST TO BE HELD
PROPOSED MEMBERS (All proposed members shall file a personal history form)
PROPOSED DATE OF TRANSFER OF MEMBERSHIP INTEREST
SPECIAL INSTRUCTIONS: Indicate the name, address, telephone and facsimile for the following: A.Notice of hearings.
B.Service of process (within State of Hawai‘i).C.Department of Liquor communications.D.License renewal.E.Financial reports.
SUBMIT: Membership Interest purchase offer. Minutes of Election of Members, when applicable. *Personal History Forms.
*Transfer of 25% or more, or person becomes owner of 25% of membership interest, file personal history form.
I hereby certify that there have been no changes in members, managers or membership interest holders except as authorized by the Liquor Commission and that each such members, managers or membership interest holders is the real party in interest of the limited liability corporation.
Authorized Signatory: Print Name:
Title: Date:
Date of Liquor Commission Approval: