State of California Edmund G. Brown Jr., Governor Department of Alcoholic Beverage Control LIMITED PARTNERSHIP QUESTIONNAIRE Instructions: Complete all items. Attach a copy of the original Limited Partnership Agreement and all amendments. One general partner must sign. 1. LIMITED PARTNERSHIP NAME 3. PREMISES ADDRESS 2. TELEPHONE NUMBER (Street number and name, city, zip code) 4. LIMITED PARTNERSHIP HEADQUARTERS ADDRESS 5. HEADQUARTERS TELEPHONE NUMBER 6. LIMITED PARTNERSHIP ATTORNEY'S NAME 7. ATTORNEY'S TELEPHONE NUMBER 8. LIMITED PARTNERSHIP ATTORNEY'S ADDRESS 9. DATE LP1 OR LP5 FILED WITH SECRETARY OF STATE (Street number and name, city, state, zip code) 10. LIMITED PARTNERSHIP AGREEMENT AND/OR 11. LAST AMENDMENT DATE CERTIFICATE HAS BEEN AMENDED YES NO 12. NAMES OF ALL GENERAL PARTNERS AND PERCENTAGE OF OWNERSHIP PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE 13. NAMES OF ALL LIMITED PARTNERS AND PERCENTAGE OF OWNERSHIP PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE I hereby certify that the above are the present general and limited partners of the limited partnership and that each such general partner and limited partner is the real party in interest with respect to his or 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 23405.1 and 23405.3 of the Business and Professions Code are hereby acknowledged and it is understood that changes within the limited partnership and/or entities holding interest in the limited partnership will be reported to the Department as required. SIGNATURE OF GENERAL PARTNER PRINTED NAME DATE SIGNED (Use reverse for additional names if needed) ABC-256 (rev. 01-11) American LegalNet, Inc. www.FormsWorkFlow.com ADDITIONAL NAMES (if needed) PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE PARTNER'S PRINTED NAME PERCENTAGE OF OWNERSHIP EFFECTIVE DATE ABC-256 (rev. 01-11) American LegalNet, Inc. www.FormsWorkFlow.com