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Form L-B (10/2019)
BUSINESS PACKET
L-B
(10/2019)
You must complete the entire Business Packet including all necessary ownership information and personal
history sheets. Select the entity page(s) that coincides with your business structure. All officers, directors,
stockholders, trustees, and beneficiaries holding ownership in this business must be disclosed.
L-C (Corporation, Trust, City, County or University)
L-LLC (Limited Liability Company)
L-P (Partnership)
L-PHS (Personal History Sheet)
If you are applying as an individual, you will submit this page and the L-PHS (Personal History Sheet).
OWNER INFORMATION
1.
Type of Owner
Individual
Limited Partnership
City/County/University
Corporation
Limited Liability Partnership
Other
Limited Liability Company
Trust
Partnership
Joint Venture
2. Owner of
Business/Applicant (Name of Corporation, LLC, etc.)
3.
Federal Employer Identification No. (FEIN)
4.
Email Address
BUSINESS INFORMATION
5.
Yes No
If “YES,” indicate type of offense and attach an explanation:
any felony offense
prostitution
bookmaking
gambling or gaming
bootlegging
vagrancy offense involving moral turpitude
any offense involving dangerous drugs, synthetic cannabinoids or controlled substances as
defined in Texas Controlled Substances Act
any offense involving firearms or a deadly weapon
more than three violations of the Texas Alcoholic Beverage Code relating to minors
violations of the Texas Alcoholic Beverage Code resulting in a criminal fine of $500
violations of an individual’s civil rights or discrimination against an individual on the basis of
race, color, creed or national origin
If “YES,” has it been five years since the termination of a sentence, parole or
probation served for any offenses indicated above?
Yes No
If “NO,” attach an explanation.
6.
Yes No
If “YES,” attach an explanation:
Page 2 of 2
Form L-B (10/2019)
The applicant, license/permit holder, agent, servant or employee may not directly or indirectly have any
overlapping ownerships or other prohibited relationships (including unfair competition and unlawful trade
practices) between those engaged in the alcoholic beverage industry at different levels, that is, between a
manufacturer and a wholesaler or retailer, or between a wholesaler and a retailer, as the words "wholesaler,"
"retailer," and "manufacturer" are ordinarily used and understood, regardless of the specific names given a
license\permit. Reference Chapter 102 et seq.
7.
Is any person, involved in this application, in violation of the above requirements?
Yes No
If “YES,” attach an explanation:
WARNING AND
SIGNATURE
If Applicant Is/Must Sign
Individual/Individual Owner
Corporation/Officer
Partnership/Partner
Limited Liability Company/ Officer or Manager
Limited Partnership/General Partner
EACH LICENSEE OR PERMITTEE SHALL HAVE EXCLUSIVE OCCUPANCY AND CONTROL OF THE
ENTIRE LICENSED LOCATION WITH RESPECT TO SALE OF ALCOHOLIC BEVERAGES. ANY
ARRANGEMENT THAT SURRENDERS SUCH CONTROL OF THE EMPLOYEES, PREMISES OR
BUSINESS, INCLUDING PROFITS AND LOSSES, TO PERSONS OTHER THAN THE LICENSEE OR
PERMITTEE IS UNLAWFUL.
WARNING: Section 101.69 of the Texas Alcoholic Beverage Code states: “…a person who makes a false
statement or false representation in an application for a permit or license or in a statement, report, or other
instrument to be filed with the Commission and required to be sworn commits an offense punishable by
imprisonment in the Texas Department of Criminal Justice for not less than 2 nor more than 10 years.”
BY SIGNING YOU ARE SWEARING TO ALL INFORMATION AND ATTACHMENTS TO THIS PACKET.
PRINT
NAME
SIGN
HERE
TITLE
Before me, the undersigned authority, on this day of , 20 , the
person whose name is signed to the foregoing application personally appeared and, duly sworn by me, states
under oath that he or she has read the said application and that all the facts therein set forth are true and
correct.
SIGN
HERE
NOTARY PUBLIC
S E A L
Page 1 of 2
Form L-C (10/2019)
CORPORATION
L-C
(10/2019)
This Corporation form should be completed for original applications or for changes of officers,
directors, stockholders, trustees, and beneficiaries holding ownership in this business. This form is
included in the Business Packet (L-B) for new applicants. License/Permit holders reporting changes
use Business Packet for Reporting Changes (L-BRC).
For more information contact your local TABC office or visit us at: www.tabc.texas.gov
ENTITY INFORMATION
1.
Federal Employer Identification Number (FEIN)
2.
Business Entity Name
3.
Filing Number
4.
Date Filed (mm/dd/yyyy)
State
Class and Number of Shares Issued
CORPORATE OWNERSHIP INFORMATION
Officer Director Stockholder Trustee Beneficiary
SSN
Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Class & No. of Shares
Last Name
First Name
MI
Title
Officer Director Stockholder Trustee Beneficiary
SSN
Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Class & No. of Shares
Last Name
First Name
MI
Title
Officer Director Stockholder Trustee Beneficiary
SSN
Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Class & No. of Shares
Last Name
First Name
MI
Title
Officer Director Stockholder Trustee Beneficiary
SSN
Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Class & No. of Shares
Last Name
First Name
MI
Title
Page 2 of 2
Form L-C (10/2019)
CORPORATE OWNERSHIP INFORMATION CONTINUED
Officer Director Stockholder Trustee Beneficiary
SSN
Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Class & No. of Shares
Last Name
First Name
MI
Title
Officer Director Stockholder Trustee Beneficiary
SSN
Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Class & No. of Shares
Last Name
First Name
MI
Title
Officer Director Stockholder Trustee Beneficiary
SSN
Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Class & No. of Shares
Last Name
First Name
MI
Title
Officer Director Stockholder Trustee Beneficiary
SSN
Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Class & No. of Shares
Last Name
First Name
MI
Title
Officer Director Stockholder Trustee Beneficiary
SSN
Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Class & No. of Shares
Last Name
First Name
MI
Title
Officer Director Stockholder Trustee Beneficiary
SSN
Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Class & No. of Shares
Last Name
First Name
MI
Title
Officer Director Stockholder Trustee Beneficiary
SSN
Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Class & No. of Shares
Last Name
First Name
MI
Title
IF YOU NEED MORE SPACE USE ADDITIONAL COPIES OF THIS PAGE
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Form L-LLC (10/2019)
LIMITED LIABILITY COMPANY
L-LLC
(10/2019)
This Limited Liability Company form should be completed for original applications or for changes of officers,
managers, and members holding ownership in this business. This form is included in the Business Packet (L-B)
for new applicants. License/Permit holders reporting changes use the Business Packet for Reporting Changes
(L-BRC). For individuals outside the United States, not holding a social security number check the "Out of
Country" box.
For more information contact your local TABC office or visit us at: www.tabc.texas.gov
ENTITY INFORMATION
1.
Federal Employer Identification Number (FEIN)
2.
Business Entity Name
3.
Filing Number
4. Member Managed or Manager Managed
Member Managed Manager Managed
5.
Date Filed (mm/dd/yyyy)
State
Class and Number of Memberships or Units Issued
LIMITED LIABILITY COMPANY OWNERSHIP INFORMATION
Officer Manager Member
SSN Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent Membership or Units Held
Last Name
First Name
MI
Title
Officer Manager Member
SSN Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent Membership or Units Held
Last Name
First Name
MI
Title
Officer Manager Member
SSN Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent Membership or Units Held
Last Name
First Name
MI
Title
Officer Manager Member
SSN Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent Membership or Units Held
Last Name
First Name
MI
Title
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Form L-LLC (10/2019)
LIMITED LIABILITY COMPANY OWNERSHIP INFORMATION CONTINUED
Officer Manager Member
SSN Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent Membership or Units Held
Last Name
First Name
MI
Title
Officer Manager Member
SSN Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent Membership or Units Held
Last Name
First Name
MI
Title
Officer Manager Member
SSN Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent Membership or Units Held
Last Name
First Name
MI
Title
Officer Manager Member
SSN Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent Membership or Units Held
Last Name
First Name
MI
Title
Officer Manager Member
SSN Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent Membership or Units Held
Last Name
First Name
MI
Title
Officer Manager Member
SSN Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent Membership or Units Held
Last Name
First Name
MI
Title
Officer Manager Member
SSN Out of Country
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent Membership or Units Held
Last Name
First Name
MI
Title
IF YOU NEED MORE SPACE USE ADDITIONAL COPIES OF THIS PAGE
Page 1 of 2
Form L-P (10/2019)
PARTNERSHIP
L-P
(10/2019)
This Partnership form should be completed for original applications or for changes of partnerships,
limited partnerships, limited liability partnerships, and joint ventures holding ownership in this
business. This form is included in the Business Packet (L-B) for new applicants. License/Permit
holders reporting changes use Business Packet for Reporting Changes (L-BRC).
For more information contact your local TABC office or visit us at: www.tabc.texas.gov
ENTITY INFORMATION
1.
Federal Employer Identification Number (FEIN).
2.
Business Entity Name
3.
Filing Number
4.
Date Filed (mm/dd/yyyy)
State
PARTNERSHIP INFORMATION
General Partner Limited Partner
SSN
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent of Interest
Last Name
First Name
MI
Title
General Partner Limited Partner
SSN
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent of Interest
Last Name
First Name
MI
Title
General Partner Limited Partner
SSN
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent of Interest
Last Name
First Name
MI
Title
General Partner Limited Partner
SSN
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent of Interest
Last Name
First Name
MI
Title
Page 2 of 2
Form L-P (10/2019)
PARTNERSHIP INFORMATION CONTINUED
General Partner Limited Partner
SSN
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent of Interest
Last Name
First Name
MI
Title
General Partner Limited Partner
SSN
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent of Interest
Last Name
First Name
MI
Title
General Partner Limited Partner
SSN
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent of Interest
Last Name
First Name
MI
Title
General Partner Limited Partner
SSN
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent of Interest
Last Name
First Name
MI
Title
General Partner Limited Partner
SSN
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent of Interest
Last Name
First Name
MI
Title
General Partner Limited Partner
SSN
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent of Interest
Last Name
First Name
MI
Title
General Partner Limited Partner
SSN
Issuing State/DL No.
Date of Birth (mm/dd/yyyy)
Percent of Interest
Last Name
First Name
MI
Title
IF YOU NEED MORE SPACE USE ADDITIONAL COPIES OF THIS PAGE
Page 1 of 2
Form L-PHS (10/2019)
PERSONAL HISTORY SHEET
L- PHS
(10/2019)
Every officer and majority owner must complete a Personal History Statement. Answer all questions. Any false statement will
disqualify you and subject you to prosecution under section 101.69 of the Texas Alcoholic Beverage Code and other criminal
statutes.
OWNER/APPLICANT
1.
Trade Name (Name of restaurant, bar, etc.)
2.
Location Address:
3.
Marital Status: Single Married Divorced Widowed
4.
Social Security Number
Issuing State/ Driver’s License Number
Date of Birth (mm/dd/yyyy)
Full Legal Name (Last, First, Middle)
Place of Birth (City, State, Country)
Email Address
Race
Sex
Height
Weight
Hair Color
Eye Color
SPOUSE
5.
Social Security Number
Issuing State/ Driver License Number
Date of Birth (mm/dd/yyyy)
Full Legal Name (Last, First, Middle)
Place of Birth (City, State, Country)
Race
Sex
Height
Weight
Hair Color
Eye Color
OTHER RESIDENT
6.
Do you live with anyone over the age of 18, other than your spouse?
YES NO
If “YES” please provide their information below: (If additional space is needed, please attach a page with information.)
Social Security Number
Issuing State/ Driver License No.
Date of Birth (mm/dd/yyyy)
Relationship
Full legal name (Last, First, Middle)
Race
Sex
RESIDENTIAL ADDRESSES
7.
List residential addresses for the past five (5) years starting with current address.
If you have not lived in Texas for the previous 12 months, you are required to provide TABC with an official copy of your criminal
background check from the FBI or state police of any state where you lived in the previous five years.
(If additional space is needed, please attach a list with the following information.)
Number and Street
City, State, ZIP
From (mm/yyyy)
To (mm/yyyy)
PRESENT
8.
Business Phone No.
Residential Phone No.
Mobile Phone No.
RESIDENT STATUS
9A.
Are you a U.S. citizen?
YES NO
B.
If “YESanswer the following:
Native Born Naturalized. If “Naturalized,” Provide the “A” Number ____________
C.
If “NO” What is your legal status in the United States? Explain below, or attach a page with information.
D.
Provide all documents such as Visa, Resident Alien, Employment Authorization Documents, etc.
TABC USE
ONLY
APPLICANT YES NO SPOUSE (BE/BG ONLY) YES NO OTHER YES NO
CH - Date Entered
/ /
Supervisor’s Signature
Destroy Date
/ /
Page 2 of 2
Form L-PHS (10/2019)
EMPLOYMENT HISTORY
10.
List employment for the past five (5) years beginning with your current employer. If self-employed or retired, include the name of your
company or company from which you retired, type of business owned or the position held prior to retirement. Include periods of
unemployment. All periods of time must be accounted for during the past five years. (If additional space is needed, attach a separate
sheet.)
Name of
Employer/Company
Address (Street, City, State, ZIP)
Position
Held/Business Type
From (mm/yyyy)
To
(mm/yyyy)
PRESENT
INDIVIDUAL FINANCIAL INFORMATION
11.
List the total amount of your personal investment in this location. Provide investment details including notes, loans, gifts,
cash, services or equipment, and operating capital. Account for the original source of all investments (how acquired).
Enter total dollar amount on the line of the amount invested column.
(If additional space is needed, attach a separate sheet.)
NOTE: If investment is in the form of a loan or gift, attach name of lender or financial institution, address, terms and
security and loan/gift documents. If from an individual, attach personal information for all individuals including:
name, social security and driver license numbers, date of birth, race, sex, etc.
Amount Invested
Original Source of Investment (loans, previous employment, etc).
$
$
$
$
$
$
$
TOTAL AMOUNT OF PERSONAL INVESTMENT
SIGN AND NOTARIZE APPLICATION
WARNING: Section 101.69 of the Texas Alcoholic Beverage Code states: “…a person who makes a false statement or false
representation in an application for a permit or license or in a statement, report, or other instrument to be filed with the Commission and
required to be sworn commits an offense punishable by imprisonment in the Texas Department of Criminal Justice for not less than 2 nor
more than 10 years.”
I, under penalty of law, hereby swear that I have read all the information provided in this document and any attachments and the
information is true and correct. I also understand any false statement or representation in this application can result in my application
being denied and/or criminal charges filed against me. I also authorize the Texas Alcoholic Beverage Commission to use all legal means
to verify the information provided.
PRINT
NAME:
AUTHORIZED
SIGNATURE:
BEFORE ME, the undersigned authority, on this day of , 20 the person whose
name is signed to the foregoing document personally appeared and duly sworn by me, each states under oath that he or she
has read the said document and that all facts therein set forth are true and correct.
SIGN
HERE:
(S E A L) Notary Public
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