Corporate Questionnaire
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Corporate Questionnaire Form. This is a California form and can be use in Department Of Alcoholic Beverage Control Statewide.
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Tags: Corporate Questionnaire, ABC-243, California Statewide, Department Of Alcoholic Beverage Control
Department of Alcoholic Beverage Control
State of California
Edmund G. Brown Jr., Governor
CORPORATE QUESTIONNAIRE
Instructions: Complete all items. One officer must sign for the corporation. Item 16 - List Certificates chronologically, including
active, canceled, and pending issuance. If stock is pledged, include date, number of shares, and from whom to whom.
1. NAME OF CORPORATION
2. ABC LICENSE NUMBER
3. PREMISES ADDRESS
4. TELEPHONE NUMBER
5. ATTORNEY'S NAME
6. ATTORNEY'S TELEPHONE NUMBER
7. ATTORNEY'S ADDRESS
8. NAME OF BANK (Corporate account)
9. ACCOUNT NUMBER
10. ADDRESS OF CORPORATE BANK ACCOUNT
11. PERSONS AUTHORIZED TO SIGN ON BANK ACCOUNT (Print)
12. INCORPORATION DATE
13. STATE OF INCORPORATION
14. SECRETARY OF STATE FILE NUMBER
15. OFFICERS AND DIRECTORS
TITLE
NAME
ADDRESS
TELEPHONE NUMBER
TITLE
NAME
ADDRESS
TELEPHONE NUMBER
TITLE
NAME
ADDRESS
TELEPHONE NUMBER
TITLE
NAME
ADDRESS
TELEPHONE NUMBER
TITLE
NAME
ADDRESS
TELEPHONE NUMBER
TITLE
NAME
ADDRESS
TELEPHONE NUMBER
16. LIST ALL STOCK CERTIFICATES
PERCENTAGE OF
CERTIFICATE
NUMBER
OUTSTANDING
DATE
DATE
NUMBER
OF SHARES
SHARES OF STOCK
ISSUED
CANCELED
TO WHOM ISSUED
□
Continued on reverse
I hereby certify the above are the present officers, directors and/or stockholders and that each such officer, director and stockholder is the real party in
interest with respect to his/her position and is not acting directly or indirectly as an agent, employee or representative of any other person not reported to the
Department. The provisions of sections 23405 and 23405.3 of the Business and Professions Code are hereby acknowledged and it is understood that
changes within the corporation and/or entities holding interest in the corporation will be reported to the Department as required.
SIGNATURE (FOR THE CORPORATION)
ABC-243 (rev. 01-11)
TITLE
DATE SIGNED
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LIST ALL STOCK CERTIFICATES (Continued from other side)
PERCENTAGE OF
CERTIFICATE
TO WHOM ISSUED
ABC-243 (rev. 01-11)
NUMBER
OUTSTANDING
DATE
DATE
NUMBER
OF SHARES
SHARES OF STOCK
ISSUED
CANCELED
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