Fillable Annual Renewal of Spirituous Liquor License Series 07 (Arizona Department of Liquor Licenses and Control)

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Annual Renewal of Spirituous Liquor License Series 07 (Arizona Department of Liquor Licenses and Control)

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The Annual Renewal of Spirituous Liquor License Series 07 (Arizona Department of Liquor Licenses and Control) form is 2 pages long and contains:

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  • 11 check-boxes
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File type: PDF

U.S.A. forms for Arizona Department of Liquor Licenses and Control

BROWSE ARIZONA DEPARTMENT OF LIQUOR LICENSES AND CONTROL (AZ) FORMS

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12/3/2019 Page 1 of 2
Individuals requiring ADA accommodations please call (602)542-9027
Arizona Department of Liquor Licenses and Control
800 W Washington 5th Floor
Phoenix, AZ 85007-2934
www.azliquor.gov
(
602
)
542-5141
Annual Renewal of Spirituous Liquor License Series 07
(Incomplete Applications Will Not Be Accepted)
RENEWALS MUST BE POSTMARKED NO LATER THAN THE EXPIRATION DATE.
THERE IS A $150 PENALTY FOR LATE FILING.
Apply to become an Arizona Lottery Commission retailer.
Job #______________
License Information
Check box if renewing multiple licenses of the same series. (See pg. 2)
License Number: ______________________________________ This License Expires on: ___________________________________________
Status:
Active Inactive (Inactive licenses, see note below)
(While in “inactive” status, a renewal application and fees for the license must be submitted to the Department of Liquor annually)
Arizona Corporation Commission # _____________________________________ (Corporation must be in good standing to renew)
Agent: ________________________________________________________________________________________________________________
Last First Middle
Owner: _______________________________________________________________________________________________________________
Name of Corporation, LLC, Company etc.
Mailing Address: _______________________________________________________________________________________________________
Street City State Zip
Business Name (Doing Business As-DBA): ________________________________________________________________________________
Business Location Address: _____________________________________________________________________________________________
Street City State Zip
Business Phone: ___________________________________ Daytime Contact Phone Number: ___________________________________
Email Address: _______________________________________________________________
Update Email on File at the Department
1. Has there been any change in percentage of ownership that affects control of the license or licensee within the last 12
months?
Yes(additional information is required, please contact http://www.azliquor.gov/contact_licensing.cfm ) No
2. Has any agent, owner, partner, LLC manager or member, corporate officer or director or shareholder holding 10 percent
or more interest in any license/licensee, been convicted of ANY felony in the past (5) years or had a liquor license revoked
within the last 12 months? Yes (attach explanation of details) No
3. Has the residential address of any agent, owner, partner, LLC manager or member, corporate officer or director or share-
holder holding 10 percent or more interest in this license or licensee changed since the last renewal application was filed at
the Arizona Department of Liquor Licenses and Control?
Yes No If yes, please list new information below.
a) __________________________________ ___________________________________________________________________________________
Name Street City State Zip
Renewal Fees Series 07
Total Per License 175.00
12/3/2019 Page 2 of 2
Individuals requiring ADA accommodations please call (602)542-9027
Additional Licenses
IMPORTANT NOTES: *While in “inactive” status, a renewal application and fees for the license must be submitted to the
Department of Liquor annually. Action is required by the applicant/licensee before 36 months of “inactive” status occurs or
the license will automatically revert to the state. ARS §4-203(G).
Licenses of the same ownership & same renewal month may be renewed using one form. Multiple license renewals, when
combined into one payment, must all be in good standing with federal, state, local governments, and Arizona
Corporation Commission for fees to be processed. Add additional pages in this format if necessary. If a business
name has changed,
please list new information below and complete a Business Information/Name Change Request
form.

ADD ADDITIONAL PAGES IN THIS FORMAT IF NECESSARY
Declaration
I,
(Print Name)___________________________________________________, declare that; 1) I am authorized by the licensee to submit
this Renewal application, have read the contents of this application and, to the best of my knowledge, believe all statements
made on this application to be true, correct and complete; 2) this application is not being made to defraud or injure any
creditor, taxing authority, regulatory authority, or transferor; 3) no other person, firm or corporation, except as indicated, has
an interest in the spirituous liquor license for which these statements are made; and 5) that none of the persons listed in
SECTIONS 1 and 3 have been convicted of a felony in the past five (5) years, except as disclosed previously.
________________________________________________
Signature
License
#
*Current
License
Status Name of Licensed Business & Physical Address County Fee
Renewal
Month
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Annual Renewal of Spirituous Liquor License Series 07 (Arizona Department of Liquor Licenses and Control)

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Completed 11 August 2020

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