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Department of Alcoholic Beverage Control State of California APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S) ABC 211 (6/99) TO: Department of Alcoholic Beverage Control File Number: 481364 31 E. Channel St. Receipt Number: 1738083 Rm. 168 Geographical Code: 3905 Stockton, CA 95202 Copies Mailed Date: (209)948-7739 Issued Date: DISTRICT SERVING LOCATION: STOCKTON First Owner: PERCIVAL TED VERNON U E C"E� 1 D Name of Business: SIMONIS FREMONT INN OCT 2 7 2009 Location of Business: 2303 W FREMONT ST STOCKTON, CA 95203-1917 ENVIRONI141ENT HEALTH County: SAN JOAQUIN PERM,T%QQERVICES Is premise inside city limits? Yes Census Tract 0009. Mailing Address: 6143 SLATON CT (If different from STOCKTON, CA 95215 premises address) Type of license(s): 47 Transferor's license/name: / Dropping Partner: Yes No License Tyne Transaction Tyne Fee Type Master Duo Date Fee 47 ON-SALE GENERAL I ANNUALFEE P40 Y 0 10/26/09 $847.00 47 ON-SALE GENERAL) STATE FINGERPRINTS NA N 2 10/26/09 $78.00 47 ON-SALE GENERAL I FEDERAL FINGERPRINTS NA N 2 10/26/09 $48.00 Total $973.00 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 premise 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 JOAQUIN Date: October 26, 2009 Under penalty of perjury, each person whose signature appears below, certifies and says: (l) He is an applicant, or one of the applicants, or an executive officer of the applicant corporation, named in the foregoing application, duly authorized to make this application on its behalf; (2) that lie 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 license(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. Applicant Name(s) Applicant Signature(s) PERCIVAL TED VERNON See 211 Signature Page