HomeMy WebLinkAboutForm - Application for Transfer of Stock (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
APPLICATION FOR TRANSFER OF STOCK
Name of Corporation dba License No.
Licensee or Authorized Representative Phone Fax
Address of Licensee or Authorized Representative E-Mail
Date of Incorporation State of Incorporation Date Registered, DCCA, State of Hawai‘i
ORIGINAL STOCK DISTRIBUTION SHARES HELD PERCENTAGE STOCKHOLDER
PROPOSED STOCK TRANSFER SHARES HELD PERCENTAGE
STOCKHOLDER*
PROPOSED OFFICERS AND DIRECTORS (All officers and directors shall file a personal history form)
PROPOSED DATE OF TRANSFER OF STOCK
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: Stock Purchase Offer. Minutes of Election of Officers, when applicable.
Personal History Forms. Official Notice of closing of stock purchase and copies of the stock certificate(s).
I hereby certify that there have been no changes in officers, directors, or stockholders except as authorized by the Liquor Commission and that each such officer, director or stockholder is the real party in interest
of the corporation.
Authorized Signatory: Print Name:
Title: Date:
Date of Liquor Commission Approval:
*Transfer of 25% or more, or person becomes owner of 25% of stock, file personal history form.
Hawai‘i County is an Equal Opportunity Provider and Employer