Department of Alcoholic Beverage Control State of California ADVICE OF CORRECTION This form is to be used for any changes that need to be made to the licensee's information. It is used for most of the miscellaneous license reporting requirements where an application is not required, including: · Transmittal of fees for Condition Modification/Removal · Reporting changes in corporations, limited liability companies, or limited partnerships that do not require an application · Reporting corrections to license information 1. LICENSE NUMBER Instructions: Complete items as appropriate. Items # 1, 4, 5, 7, 9 should be the licensee's current information before the change. When this form is completed, it must be submitted to the District office. 2. RECEIPT NUMBER 3. FEE PAID 4. LICENSEE'S NAME 5. DOING BUSINESS AS (DBA) 6. DATE 7. PREMISES ADDRESS (Street number and name, city, zip code) 8. DISTRICT OFFICE 9. MAILING ADDRESS (Street number and name, city, state, zip code) 10. LICENSEE'S PHONE NUMBER 11. TYPE OF PENDING APPLICATION 12. DATE APPLICATION FILED 13. ABIS UPDATED UPDATED BY (INITIALS) 14. DOCUMENT EXPLAINING CHANGE ATTACHED Yes 15. ACTION OR CHANGE a. b. c. d. No ________ Yes No Corporate Change - Section 23405 (Attach ABC-243) g. h. DBA Change (Attach letter, if any, from licensee) LP Change - Section 23405.1 (Attach ABC-256) LLC Change - Section 23405.2 (Attach ABC-256-LLC) Premises Address Change by City or County (Attach letter from city or county) Condition Modification/Removal - Section 23803 (ABC-333 to follow to HQ H&L) i. Name Change (Attach official document; e.g., certificate from Secretary of State, court order, e. f. Mailing Address Change Replacement of Lost License (Attach letter, if any, from licensee) j. marriage certificate) Other 16. DETAILS OF CHANGE OR PAYMENT (e.g., annexation into city, fee for Code 8, etc.) 17. RECOMMENDATION (Required for Items 15a-c only) INVESTIGATOR'S SIGNATURE DATE SIGNED 18. RECOMMENDATION (Required for Items 15a-c only) SUPERVISOR'S SIGNATURE DATE SIGNED Distribution: Original to HQ Licensing (If replacement of lost license, original to HQ Cashier with Transmittal); Copy to District file ABC-219 (rev. 9/11) American LegalNet, Inc. www.FormsWorkFlow.com