HomeMy WebLinkAboutForm - Application for Alcohol Purchase Permit (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@hawaiicounty.gov
APPLICATION FOR ALCOHOL PURCHASE PERMIT
Pursuant to Rule 3-2-D.6, Rules and Regulations of the Liquor Commission of the County of
Hawai‘i, application is hereby made for an Alcohol Purchase Permit, as follows:
Applicant:
Address:
Telephone: Fax: E-mail:
Vendor’s Name, Address, Telephone/Fax:
Address Where Product Shall Be Stored and Used:
Name of Product: Quantity Requested:
Nature of Use:
Attach: Personal History Form of Applicant
Sketch of Premises to indicate alcohol storage area.
By (Signature)
Name:
Date:
Phone No.:
PERMIT
Your application for an alcohol purchase permit is approved effective
and shall expire on or upon purchase of the total quantity of alcohol,
whichever occurs first. The permit shall be renewable upon submittal of an application to the Liquor Commission.
Conditions: The term of the permit shall be for one year from the date of issuance.
By Director, Department of Liquor Control
Date:
Ratified by the Liquor Commission on:
Date:
Hawai‘i County is an Equal Opportunity Provider and Employer