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ig__ L Department of Alcoholic Beverage Control State of California APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S) ABC 211 (6199) TO:Department of Alcoholic Beverage Control File Number: 570954 31 E CHANNEL ST Receipt Number: 2369833 ROOM 168 Geographical Code: 3903 STOCKTON, CA 95202 Copies Mailed Date: June 30,2016 (209)948-7739 Issued Date: RECEIVED DISTRICT SERVING LOCATION: STOCKTON JUL 0 12016 First Owner: THE CAJUN SPOT,LLC Name of Business: CAJUN SPOT �R�LlER HEALTH Location of Business: 283 W LOUISE AVE A� jr� ��10ES MANTECA,CA 95336 County: SAN JOAQUIN Is Premise inside city limits? Yes _ Census Tract 0051.26 — -� - Mailing Address:— (If different from premises address) Type of license(s): 41 Transferor's license/name: Dropping Partner: Yes_ No_ License Type Transaction T e Fee T e Master Dup Date Fee 41-on-sale Beer And Wint ANNUAL FEE NA Y 0 06/30/16 $350,00 41-On-Sale Beer And Wint ORIGINAL FEES NA Y 0 06/30/16 $300.00 NA FEDERAL FINGERPRINTS NA N 1 06/30/16 $24.00 NA STATE FINGERPRINTS NA N 1 06/30/16 $39.00 Total $713.00 Have you ever been convicted of a felony? No Have you ever violated any provisions of the Alcoholic Beverage Control Act, or regulations of the Department pertaining to the Act? No Explain any"Yes"answer to the above questions on an attachment which shall be deemed part of this application. Applicant agrees(a)that any manager employed in an 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. STATE OF CALIFORNIA County of SAN JOAQUI N - Date: June 30, 2016 Under penalty of perjury,each person whose signature appears below,certifies and says:(1) He is an applicant,or one of the applicants,or an executive officer ofthe applicant corporation,named in the foregoing application,duly authorized to make this application on its behalf,(2) that he has read the foregoing and knows the contents thereof and that each of the above statements therein made are true;(3) that no person other than the applicant or applicants has any direct or indirect interest in the applicant or applicant's business to be conducted under the Iicense(s)for which this application is made'. (4) that the transfer application or proposed transfer is not made to satisfy the payment of a loan or to fulfill an agreement entered into more than ninety (90)days preceding the day on which the transfer application is filed with the Department or to gain or establish a preference to or for any creditor or transferor or to defraud or injure any creditor of transferor,(5) that the transfer application may be withdrawn by either the applicant or the licensee with no resulting liability to the Department. Effective July 1,2012,Revenue and Taxation Code Section 7057,authorizes the State Board of Equalization and the Franchise Tax Board to share taxpayer information with Department of Alcoholic Beverage Control.The Department may suspend,revoke,and refuse to issue a license if the IicenseeLs name appears in the 500 largest tax delinquencies list.(Business and Professions Code Section 494.5.) Applicant Name(s) Applicant Signature(s) See 211 Signature Page THE CAJUN SPOT,LLC