Department of Alcoholic Beverage Control State of California PRIORITY APPLICATION SIGNATURE SHEET Instructions: Complete Items 1-4, read carefully, and sign. In all cases, one signature will suffice. Signature must be notarized in accordance with the laws of the state where signed. Item #1 - Enter the name of the applicant. For a general partnership, list the names of the individual partners. For a limited partnership, limited liability company, or a corporation, list the name of the entity. 1. APPLICANT(S) NAME(S) (If Individual, state first, middle, last) 2. TELEPHONE NUMBER 3. DATE 4. MAILING ADDRESS (Street number and name, city, state, zip code) I hereby apply for a priority number for an Alcoholic Beverage License (established under the provisions of Sections 23817, 23820 and 23821 of the Business and Professions Code). 1. I agree that I will not apply at premises actively licensed with a license of the same type. I further agree that I will not apply at a location at which I hold any interest in a license of the same type surrendered to the Department under Rule 65, California Code of Regulations. 2. I further agree that: (a) Application for Alcoholic Beverage License, Form ABC-211, will be filed within ninety days of notification of eligibility to file the application. The application will be made in the same name(s) as appears above. After the close of the priority application period and before the license is issued, no changes may be made as to the applicant entity except adding a spouse or dropping a partner. (b) I will place the license in use within six months of the date I filed the Form ABC-211; or if the application is for premises to be constructed (Section 24044), that construction will be substantially underway within six months of Department approval, and that the license will be placed into use at the newly-constructed premises within 12 months of the date of the approval; provided, however, in the event of a protest or petition, the six- and twelve- month periods set forth above shall commence as of the date of the Department’s final decision. If the above conditions are not met, I agree that the application is automatically withdrawn, and the application fee, less service charge is to be refunded, or, if the license has been issued under Rule 64(b), the license shall be revoked. 3. I agree that: I will not apply for an off-sale general license at premises for which an on-sale general license is issued nor apply for an on-sale general license at premises for which an off-sale general license is issued, unless the on-sale business and the off-sale business are to be physically separated and operated independently of each other and the privileges thereby granted are to be fully exercised in a bona fide manner. 4. I agree that: (a) An application for an on-sale general license will be for premises to be operated as a bona fide public eating place. (b) An application for an off-sale general license will be for premises which are open to the public. (c) An application for a special on-sale general license will be for a premises to be operated as a club as provided for under Section 23399.2. 5. I agree that: I will sign a Petition for Conditional License, restricting the transfer of the license to be issued, as a part of the Application for Alcoholic Beverage License, Form ABC-211. APPLICANT'S CERTIFICATION Under penalty of perjury, I certify that: (a) The above applicant has no interest in any other priority application for the same type of license in the same county and drawing. Executed at PRINTED NAME OF PERSON SIGNING FORM (b) The only interest the above applicant has in another priority application for the same type of license in the same county is an existing original or intercounty application. , this day of , 20 . APPLICANT SIGNATURE ABC-213-SIG (5/06) American LegalNet, Inc. www.FormsWorkflow.com