State of California Department of Alcoholic Beverage Control APPLICATION FOR REINSTATEMENT Instructions: · This form is used to apply for reinstatement after cancellation. · You may submit this application in person or by mail. If you apply in person, the District Administrator may grant permission for you to immediately begin selling alcoholic beverages. If you apply by mail, you cannot sell alcoholic beverages until you receive your license certificate in the mail. The licensee of record must sign this form. One signature will suffice. For a general or limited partnership, one general partner must sign. For a corporation, one officer must sign. For a limited liability company, an authorized manager, member or officer must sign. Form must be notarized if not witnessed by an ABC employee. LICENSE NUMBER RECEIPT NUMBER · FEE PAID $ PAYMENT TYPE · Cashier's Check Money Order I hereby apply for the reinstatement of my license. 1. LICENSEE NAME 2. PREMISES ADDRESS (Street number and name, city, zip code) 3. MAILING ADDRESS (Street number and name, city, state, zip code) 4. LICENSE TYPE 5. STATUS 6. TRANSFEREE NAME Transfer Pending Rule 65 I understand that: · I must pay the renewal fee on my license by · If I do not pay the renewal fee and 100% penalty fees by license will be revoked. · If I do not renew my license on time in the future, I will not be given immediate privilege to sell alcoholic beverages; I will have to wait until my new license issues before I can begin selling alcoholic beverages. LICENSEE SIGNATURE (Must be notarized if submitting by mail) DATE SIGNED of each year. , my · Failure to renew my license by the renewal due date in the future will result in penalty fees. RECOMMENDATION DISTRICT ADMINISTRATOR DATE SIGNED Approval Yes Denial No IMMEDIATE REINSTATEMENT APPROVED Distribution: Original to Headquarters; Copy to District Office; Copy to Applicant ABC-292 (3/00) American LegalNet, Inc. www.FormsWorkflow.com