Application For Transfer Of Interest
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Application For Transfer Of Interest Form. This is a Connecticut form and can be use in Department Of Consumer Protection Statewide.
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Tags: Application For Transfer Of Interest, Connecticut Statewide, Department Of Consumer Protection
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
Liquor Control Division
Telephone: (860) 713-6210
Fax: (860) 713-7235
Website: http://www.ct.gov/dcp
APPLICATION FOR TRANSFER OF INTEREST
Backer:________________________________________Phone #:_______________________
Permittee:____________________________________________________________________
Business Address:______________________________________________________________
Permit #:________________________TOTAL PERCENTAGE IN LLC __________________
NAME OF PRESENT INTEREST HOLDERS IN LLC:
PROPOSED MEMBERS & TOTAL INTEREST HELD:
Please indicate below if any of the proposed members/shareholders now hold a permit from this
Department as a permittee or backer, including partner or stockholder (other than applicant).
NAMES OF MEMBERS
TOTAL INTEREST HELD
DO ANY NEW LLC MEMBERS HOLD AN INTEREST IN ANY OTHER PERMIT
PREMISES?
YES
NO
If YES, PLEASE GIVE PERMIT NUMBER:_____________________________________
Requested by:_________________________________________________________________
(Name)
_________________________
(Date)
_________________________________________________________________________________________________
(Street Address)
(Town)
(State)
(Zip Code)
_________________________________________________________________
(Phone Number)
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