ATT-188 (Rev. 4/11) NOTIFICATION MUST BE RECEIVED BY THIS OFFICE TWO WEEKS BEFORE THE SCHEDULED EVENT State of Georgia Department of Revenue Douglas J. MacGinnitie Commissioner Howard A. Tyler Director Alcohol & Tobacco Division Suite Number 4235 1800 Century Blvd., N.E. Atlanta, Georgia 30345 (404) 417-4900 NOTIFICATION FOR ALCOHOL SET / RESET FROM: Company Name: Telephone Number: Fax Number: E-mail Address: Trade Name: Store Number: Location Address: City: License No. (If Issued): STI No. (If Issued): State: Zip: REASON FOR SET / RESET (Please check one): Marketing purposes, not to exceed one reset per year Change of ownership of the retail dealer’s business New store Remodeled store construction TYPE OF SET / RESET: Beer Wine Liquor DATE OF SET / RESET: Scheduled Date of Set / Reset Scheduled Time of Set / Reset Date of Last Set / Reset Written notification must be furnished to all applicable wholesalers of this set / reset at least two weeks prior to the scheduled event date. Participation in the approved set / reset by wholesalers is entirely optional. This form must be typed. Notifications submitted with incomplete information or fields will be rejected. Notifications should be submitted electronically by e-mail to atdiv@dor.ga.gov or by fax at (404) 417-4871. An Equal Opportunity Employer American LegalNet, Inc. www.FormsWorkFlow.com