Department of Alcoholic Beverage Control CORPORATE QUESTIONNAIRE1.NAME OF CORPORATION2.ABC LICENSE NUMBER3.PREMISES ADDRESS4.TELEPHONE NUMBER5.ATTORNEY'S NAME6.ATTORNEY'S TELEPHONE NUMBER7.ATTORNEY'S ADDRESS8.NAME OF BANK (Corporate account)9.ACCOUNT NUMBER10.ADDRESS OF CORPORATE BANK ACCOUNT11.PERSONS AUTHORIZED TO SIGN ON BANK ACCOUNT (Print)12.INCORPORATION DATE13.STATE OF INCORPORATION14.SECRETARY OF STATE FILE NUMBER15.OFFICERS AND DIRECTORSTITLENAMEADDRESSTELEPHONE NUMBERTITLENAMEADDRESSTELEPHONE NUMBERTITLENAMEADDRESSTELEPHONE NUMBERTITLENAMEADDRESSTELEPHONE NUMBERTITLENAMEADDRESSTELEPHONE NUMBERTITLENAMEADDRESSTELEPHONE NUMBER16.LIST ALL STOCK CERTIFICATESPERCENTAGE OFCERTIFICATENUMBEROUTSTANDINGDATEDATETO WHOM ISSUEDNUMBEROF SHARESSHARES OF STOCKISSUEDCANCELEDContinued on reverseSIGNATURE (FOR THE CORPORATION)TITLEDATE SIGNEDABC-243 (rev. 01/1) I hereby certify the above are the present officers, directors and/or stockholders and that each such officer, director and s toc kholder 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. State of California Gavin Newsom, Governor 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. American LegalNet, Inc. www.FormsWorkFlow.com LIST ALL STOCK CERTIFICATES (Continued from other side) PERCENTAGE OFCERTIFICATENUMBEROUTSTANDINGDATEDATETO WHOM ISSUEDNUMBEROF SHARESSHARES OF STOCKISSUEDCANCELEDABC-243 (rev. 01/1) American LegalNet, Inc. www.FormsWorkFlow.com