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Do Not Write Above This Line—For Headquarters Office ... — APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S) Original Application To: Department of Alcoholic Beverage Control Transfer Application 1215 0 Street, P. 0. Box 1139 Person to Person Sacramento 5, California Premises to Do Not Write In Space Within Heavy Una FILE NO. Ill FEE NO. • Premises . The undersigned hereby applies for COPY licenses described as follows: Exchange Applied under Effective Date: CODE Issuedper e m •• TNewype LicensesiN Sec. 24044 1. NAME(S) OF APPLICANT(S) 2. TYPE(S) OF LICENSE(S) 3. FEE W69 /6 2— A,4" $ / ._ _ i _v._ i•-;') , RECEIPT NO. TOTAL $ 35 , )2/ /Me 4. Name of Business 5. If Premises Licensed, Show Type of License 6. Are Premises inside City Limits? 7. Location of Business—Number and Street City and Zone County Mailing Address (I differ nt from 7) , 7" , 'I/II /6 -a-- CV 1--A_.k. -4 (1 (51---1.---e-t-1..-c. 9.5— io,--,,,4 ,I,e-,,,,C..,— Have you ever been arrested or cited? 1,6. Have you ever violated any of the provisions of the Alcoholic / Beverage Control Act or regulations of the Department per- Have you ever been convicted of a felony? taming to the Act? Explain a "YES" answer to items 9, 10 or 11 in this space, or on an attachment. Applicant agrees (a) that any manager employed in the business 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, particularly any of the pro- visions of Sections 25500 to 25506 and 25611 to 25616 inclusive of said Act, or regulations of the Department pertaining to the Act. I am/we are aware of the provisions of Section 3700 of the Labor Code which requires every employer to be insured against liability for workmen's compensation. The name of my/our workmen's compensation insurance carrier is: STATE OF CALIFORNIA County of , Date 15. COPIES MAILED Under penalty of perjury, each person whose signature appears below, certifies and says: (1) He is the 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 he has read the foregoing application and knows the contents thereof and that 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 applicant's or applicants' 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 of transferor or to defraud or injure any creditor of transferor. APPLICANT SIGN HERE APPLICATION BY TRANSFEROR STATE OF CALIFORNIA County of Date 18. File No. Under penalty of perjury each person whose signature appears below, certifies and says: (1) He is the licensee, or an executive officer of the corporate licensee, named in the foregoing transfer application, duly authorized to make this transfer application on its behalf; That he hereby makes uppliculiun to surrender all interest in the attached license(s) described below and to transfer same to 'the applicant and/or location indicated on the upper portion of this application form, if such transfer is approved by the Director; 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 days preceding the day on which the transfer application if filed with the Department or to gain or establish a preference to or for any creditor of transferor or to defraud or injure any creditor of transferor. 20. License Number(s) Location Number and Street City County TRANSFEROR SIGN HERE --------- ____• ABC 21IA (9 -61) 55156 12-61 201,1 SEPT 0A SPO 19. Name(s) of Licensee(s)