6601 Campstool Road Cheyenne, Wyoming 82002 - 0110 Chartered Transportation Liquor License Application LICENSING TERM: to License #: Type of Business: Railroad Bus Limousine (Other) Type of License Applied for: Railroad: Annual (Fee $250.00) 24Hr (Fee $25.00) Charter (Bus/Limo): Annual (Fee $250.00) 24Hr (Fee $25.00) Applicant: Bus iness Name (DBA): Contact Person: Phone #: Email Address: Company Location : City: State: Zip: Mailing Address: City: State: Zip: Vehicle License Plate: Is the above information correct? Yes No If No, Please update. FILING AS (CHOOSE ONLY ONE) INDIVIDUAL PARTNERSHIP CORPORATION LLC LLP NOTE: Individual and Partnership filers must be domiciled residents of Wyoming for at least one year and not claimed residence in any other state in the last twelve months, and provide personal information in table below. Applicants Legal Name Date of Birth DO NOT LIST PO BOX ES Residence Address, Street, City, State & Zip Residence Phone Number Have you been a DOMICILED resident for at least 1 year and not claimed residence in any other statein the last year? Have you been Convicted of a Felony Violation? Have you been Convict ed of a Violation Relating to Alcoholic Liquor or Malt Beverages? YES NO YES NO YES NO YES NO YES NO YES NO (If more information is required, complete in identical form, on a separate piece of paper and attach to this application.) / / $ Cash Recpt #: Check Ck #: Processed by: Payment Processed: / / Control Number: American LegalNet, Inc. www.FormsWorkFlow.com If a corporation, LLC or LLP list the full names and residence address of all the officers and directors and of all shareholders owning jointly or severally ten percent (10%) or more of the stock of the corporation, LLC or LLP. Use back of form if additional space is needed. Applicants Legal Name Date of Birth DO NOT LIST PO BOXES Residence Address, Street, City, State & Zip Residence Phone Number For corp or LLC. No of years in corp or LLC For corp or LLC. % of Stock Held Have you been Convicted of a Felony Violation ? Have you been Convicted of a Violation Relating to Alcoholic Liquor or Malt Beverages? YES NO YES NO YES NO YES NO (If more information is required, complete in identical form, on a separate piece of paper and attach to this application.) By filing this application, I agree to operate in Wyoming under the requirements of W.S.12-2-202 and all other applicable Wyoming laws and rules, and to file required sales tax reporting documents and taxes. By signing this application, I acknowledge for (Business Name) that all of the information provided is true and correct, and that I agree to meet the Wyoming operating conditions specified above. This application must be signed by an owner, partner, corporate office or LLC/LLP member. VERIFICATION OF APPLICATION (Requires signatures by ALL Individuals, ALL Partners, ONE (1) LLC Member, TWO (2) Corporate Officers or Directors, except that if all the stock of the corporation is owned by ONE (1) individual then that individual may sign and verify the application upon his oath, or TWO (2) Club Officers.) W.S.12-4-102(b) Under penalty of perjury, and the possible revocation or cancellation of the license, I swear the above stated facts, are true and accurate. Dated this day of, 20. Applicant Applicant American LegalNet, Inc. www.FormsWorkFlow.com