P-12 Request-Acknowledgement Form
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P-12 Request-Acknowledgement Form. This is a California form and can be use in Department Of Alcoholic Beverage Control Statewide.
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Tags: P-12 Request-Acknowledgement Form, ABC-811, California Statewide, Department Of Alcoholic Beverage Control
P-12 Request/Acknowledgement Form The following is to be completed by an applicant who currently holds more than one permanent license(s) issued by the Department and has been granted, or is requesting, P-12 status: LICENSEE/APPLICANT: CHECK ONE: Our designated base/master file is held in the Department's ________________ District Office under file number __________. We are requesting P-12 status under file number ____________ held in the Department's __________________ District Office. We hereby request waiver of submission of documents which would otherwise be required to establish our qualification as an applicant for an alcoholic beverage license. We hereby attest, under penalty of perjury, that all information (including forms ABC-208 [Personal Affidavit], ABC-243 [Corporate Questionnaire], ABC-256 [Limited Partnership Questionnaire], ABC-256-LLC [Limited Liability Questionnaire] and all related supporting documents) in the above-identified licensing file are accurate and current. We understand that we are required to report any changes to our licensed entity, pursuant to Business and Professions Code Sections 24071, 24071.1, and/or 24071.2, and California Code of Regulations Rule 68.5. We recognize that a determination by the Department that this statement is materially false could lead to denial of this application and/or disciplinary action against license(s) held by the applicant. _______________________________________ Signature of applicant ________________ Date ABC-811 (04/13) American LegalNet, Inc. www.FormsWorkFlow.com
