Waiver Of Operation Application
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Waiver Of Operation Application Form. This is a Alaska form and can be use in Alcoholic Beverage Control Board Statewide.
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Tags: Waiver Of Operation Application, Alaska Statewide, Alcoholic Beverage Control Board
Alcoholic Beverage Control Board
5848 E Tudor Rd
Anchorage, Alaska 99507
(907) 269-0350
FAX (907) 272-9412
AS 04.11.330(a)(3)
15 AAC 104.170
Waiver of Operation
Application
License Information
Fees*
Liquor License Number:
Waiver Fee
$
License Type:
$ 1,000.00
Local Governing Body: (City, Borough or Unorganized)
Penalty
(If applicable)
________________
Total Submitted
Name of Licensee:
*The fee is non-refundable [15 AAC 104.170(c)]
Doing Business As (Business Name)
Telephone Number:
Mailing Address:
________________
$
Street Address or Location of Business
City:
Waiver Request Information
This waiver application is the:
Waiver Request for Calendar Year:
1st Request
2nd Request
Is this license for sale?
Yes
3rd Request
Other _______
No
Explanation of the circumstances for non-operation of license. Include relevant information as to why
the license was not operated, any future plans for operating the license and projected timelines. Attach
additional sheets if necessary.
Signature of Licensee(s)
Signature
Signature
Name (Please Print)
Name (Please Print)
Date
Date
WaiverApp 8/02
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