Print Form State of Arizona Department of Liquor Licenses and Control BUSINESS DATA REPORT THIS FORM IS REQUIRED TO RENEW SERIES 11 AND 12 LICENSES WHICH HAVE BEEN IN OPERATION FOR A PERIOD OF TWELVE MONTHS OR LONGER. Licensee’s Name: ________________________ D.B.A.: ________________________________ License #: ______________________________ Time period included in this report: ___/___/_____ through ___/___/_____ mo day year mo day year (please report your sales for the reporting period that include the 12 months preceding your license expiration date) Sales Information Food Sales Total Liquor Sales Month/Year Total Sales Totals Food Inventory Value (most recent) Beer Wine Liquor Total (exclude nonfood items) Dollar Amount I certify that all information presented on this report is true and accurate: Signature: Title: Date:__/__/___ 800 W. Washington, 5th Floor Phoenix, Arizona 85007 Website: www.azliquor.gov INDIVIDUALS REQUIRING ADA ACCOMODATIONS CALL 602-542-9051 Revised 6/2010 American LegalNet, Inc. www.FormsWorkFlow.com