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c0 Py � Pi 6s/s,� ��/ De twt de/ash--R.fRFe colt copies DO Nes WritTAMvo This Uwe—for Moedgoerlfvs ORIn Only A►PLICATION FOR ALCOHOLIC BEVERAGE LICENSE(SI 1. TYPES) OF LICENSE(S) FILE NO. To: Department of Alcoholic Beverage Corr VIRONMENTAL I EALTH RECEIPT NO., 1901 Broadway ;k33nd for PERMIT SERVI 3E Sacramento, Calif. 95818 GEOGRAPHICAL (msrwlcya A .' t I PM t S8 CODE ? )f`r, The undersigned hereby applies for Date licenses described as follows: Issued Temp. Permit 2. NAME(S) OF APPLICANT(S) Applied under Sec. 24044 ❑ Effective Date: I S.,- 1 .- Effective Date: 3. TYPE(S) OF TRANSACTION(S) FEE LIC. TYPE nnenn XX7 x Oriainal ADnlicatio $ xxaAxnrx Annual . Fee 104no 4. Name of Business 5. Location of Business—Number and Street City and Zip Code County TOTAL $ `14 n f' 6. If Premises Licensed, 7. Are Premises Inside Show Type of License City Limits? 8. Mailing Address (if different from 5)—Number and Street ftemv) (p..m) 9. Have you ever been convicted of a felony? 10. Have you ever violated any of the provisions of the Alcoholic Beverage Control Act or regulations of the Department per- taining to the Act?. 11. Explain a "YES" answer to items 9 or 10 on an attachment which shall be deemed part of this application. 12. Applicant agrees (a) that any manager employed in on-sale licensed premises will have all the qualifications of a licensee, and (b) that he will not violate or cause or permit to be violated any of the provisions of the Alcoholic Beverage Control Act. 13. STATE OF CALIFORNIA County of --------------------------------------Date-------------------------- ---------------------- -----Date-----_-----_--------------Under penally of ",I.... each person -hese s19noture appears below, <enires and says: (1) He is the applicant, or one of she appfcanls, or an axecut. officer of the applicant rorpn.1i.n, named in the foregoing opplimrion, duly ourhorixed to make this application on ns beholf; (2) Thor he has read he far. going application and knows the contents thereof and rhar each and all of the statements therein made are true; (3) that no person other than the applicant or applicants has any direct or indirect interest in the applicants Of applicant' business to be conducted under the lic.nselsl for which this application is made; (4) that the transfer opplimrion or proposed transfer is nor made to $.list, rhe payment of a loan or to fulfill an agreement entered into more a than ninety 1901 days preceding he day on which rhe lrorwfer application is filed with the Department or to gain ors establish a preference to or fora creditor of transferor or to defraud or iniure any creditor of rransfeior; (sis that the vonsfer application may be wlrhdrown by either the applicant or she licenseewith no resulfng liability la the Deportment. y 14. APPLICANT ?,•..-,, - SIGN HERE --- — — ----------- ---------- fl y APPLICATION BY TRANSFEROR 15. STATE OF CALIFORNIA County of-------------------------------------Date----------------------------- Under "nasty of perjury each person whose signal.., appears below, corifies and sa,s: (1) He is the licensee, or o executive officer of the mrpoxate licensee. mri wed in the foregoing transfer opplion, duly authorized to make this transfer aPPI;C.IiO- anit behalf; (2) that he hereby makes application re s ender all interest in he anached lien»(s) described bele- and t. transfer some to rhe applicant and or location indicated on the upper portion of this application form, if wch va .for I. approved by the Director; (3) 'hot the confer -PPI;,-"-' or proposed transfer is not made to satisfy the payment of p Ipan Or to fulfill oWeement entered into mon than ninety days preceding he day an which rhe r.en piwatfwn 11sall with the Department or In 9arn er establish a preference to or for any creditor of rronsfemr or to defraud or injure any creditor of Tronslerar; (4) rhar the transfer application may be withdrawn by tither the applicant or the licensee with no nsvW., liability m the Departm,nt. 16. Name(s) of Licensee(s) 17. Signature(s) of Licensee(s) _ 18. license Number(s) � bbini'IBI' ___ww. J4{5 s•9i1Du ��gbbLDr`SQ�k_..--D et lit usiitw) Number-and S i"cO�014; -"City and Zip Code County 19. location �4r u4.? G,IGIj I I S Do Not Write Below This Line; For Department.G(se_,,"Y' Z ev ❑ L11E ._ . e Attached: ❑ Recorded notice, •. ':-y�fi'} :x,1 JOIA — - ❑ Fiduciary papers, Ly `f X5:10 11 I l l ritr if - tonjot i f i orstew s --------------------COPIES MAILED ------------------------------------------- ❑ Renewal: Fee of.-----------Paid at.----------------------------Office on-----------------Receipt No. ----------------5----- �93051 ABO 211 0-821 - -