12/3/2019 Page 1 of 2
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Arizona Department of Liquor Licenses and Control
800 W Washington 5th Floor
Phoenix, AZ 85007-2934
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.
Check box if renewing multiple licenses of the same series. (See pg. 2)
License Number: ______________________________________ This License Expires on: ___________________________________________
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)
Last First Middle
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
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