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without prior approval of such interest by the Liquor Commission and that no liquor license issued to Applicant has been revoked within the term of two years preceding the date of this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