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Department of Alcoholic Beverage Control State of California <br /> APPLICATION FOR ALCOHOLIC BEVERAGE LICENSES) <br /> ABC 211(6/99) <br /> TO:Department of Alcoholic Beverage Control File Number: 630428 <br /> 31 E CHANNEL ST Receipt Number: 2684475 <br /> ROOM 168 Geographical Code: 3900 <br /> STOCKTON, CA 95202 Copies Mailed Date: September 20,2021 <br /> (209)948-7739 Issued Date: <br /> DISTRICT SERVING LOCATION: STOCKTON - FIVE D <br /> First Owner: ORTIZ, MATHEW ALBERT <br /> Name of Business: HEIRLOOM KITCHEN <br /> Location of Business: 61 LINCOLN CTR LNiIIdVD�S){. E <br /> STOCKTON,CA 95207-2606 4)1i1';�R"1'i�17Cly 1 , <br /> County: SAN JOAQUIN <br /> Is Premises inside city limits? No Census Tract: 0031.10 <br /> Mailing Address:(If different PO BOX 7748 <br /> from STOCKTON,CA 95267 <br /> premises address) <br /> Type of license(s): 41 Dropping Partner: Yes_ No_ <br /> Transferor's license/name: 501597 / PIJL,LISA <br /> License Type Transaction Tyne Master Secondary LT And Count <br /> 41-On-Sale Beer And Wine-Eating P PER Y <br /> License Type Transaction Description Fee Code Dup Date Fee <br /> Application Fee STATE FINGERPRINTS NA 2 09/20/21 $78.00 <br /> Application Fee PERSON TO PERSON TRF NA 0 09/20/21 $335.00 <br /> Application Fee FEDERAL FINGERPRINTS NA 2 09/20/21 $48.00 <br /> 41-On-Sale Beer And Wine-Eat ANNUAL FEE NA 0 09/20/21 $455.00 <br /> Total $916.00 <br /> Have you ever been convicted of a felony? No <br /> Have you ever violated any provisions of the Alcoholic Beverage Control Act,or regulations of the <br /> Department pertaining to the Act? No <br /> STATE OF CALIFORNIA County of SAN JOAQUIN Date: September 20,2021 <br /> Applicant Name(s) <br /> ORTIZ,MATHEW ALBERT <br /> ORTIZ,VICTORIA KATHRYN <br />