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Solicitors License Renewal Form. This is a District Of Columbia form and can be use in Alcoholic Beverage Regulation Administration Statewide.
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Tags: Solicitors License Renewal Form, District Of Columbia Statewide, Alcoholic Beverage Regulation Administration
Government of the District of Columbia
Alcoholic Beverage Regulation Administration
For Official Use Only
License Period:
Initials:
SOLICITOR’S LICENSE RENEWAL FORM
Date:
SOLICITOR’S INFORMATION –Please indicate if any of the following have occurred since the last renewal period:
1. Please place an ‘X” in the applicable box below:
Name Change
Change in Employment
(Submit an employment certificate letter from your current employer)
Address Change
2. Solicitor’s
Application Number
3. License
Number
4. Solicitor’s Name
Last
First
Middle
5. Home Address
Number
Street
6. Home Telephone
City/State
Zip code
7. Business Telephone
EMPLOYER INFORMATION
8. License Number
9. License Class
10. Licensee’s Name
11. Establishment’s
Telephone
12. Establishment’s
Address
Number
Street
City/State Zip code
13. Certification: I hereby certify under perjury that the information in this application and attachments are true and correct to the best of my
knowledge and belief. I will also conform to all laws and regulations related to the alcohol and beverage license for which I have applied.
____________________________
Signature
Subscribed and sworn to before me
on this _____ day _____, 20___.
____________________________
Notary Public
My commission
expires on _____________.
14. Please answer the question: In what language do you need vital documents translated, if any?
15. Since your last application, have you been convicted of a felony or misdemeanor? □ Yes □ No. If yes, please attach the disposition to the application.
INSTRUCTIONS FOR FILING A RENEWAL APPLICATION FOR A SOLICITOR’S LICENSE APPLICATION
Current solicitors’ licenses expire at the end of June 2005. Please be advised that all solicitors can renew beginning June 1, 2005. The annual fee is $325. The two
year renewal fee is $650 and the three year renewal fee is $975. Our hours are 8:30 am to 3:30 pm, but we also encourage the solicitors to come renew during the
off-peak hours of 8:30 to 10:30 am to avoid long lines in the Customer Service Center. Under no circumstances will anyone be processed after 3:30 pm. Failure
to renew timely could result in a late penalty of $50. Please read all questions carefully. Each question must be answered.
1. Please place an “x” to indicate if there is a name, address, or employment change.
2. Print your application number.
3. Print your license number.
4. Print your name (Last Name, First Name, Middle Initial).
5. Print your home address.
6. Print your home telephone number.
7. Print your business telephone number.
8. Print your employer’s license number.
9. Print your employer’s license class.
10. Print your wholesaler’s name that appears on the ABC license.
11. Print the wholesaler’s telephone number.
12. Print the wholesaler’s address as it appears on the ABC license.
13. Certification/Affidavit: Please read, and have your signature notarized.
14. Please answer the question: In what language do you need vital documents translated, if any?
15. Please check the appropriate box to answer if you have been convicted of a felony or misdemeanor since your last application. If you answered “yes”,
please attach a copy of the disposition of the conviction to your renewal application form.
SPECIAL NOTICE
The District of Columbia will provide appropriate auxiliary services including sign language interpreters whenever necessary to effectuate communication with
members of the public who are deaf, hard of hearing or who may have other disabilities affecting communication. Please contact the ADA coordinator at (202)4424423.
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