Alcohol Beverage Control PO Box 700 Meridian ID 83680 Phone: (208) 884-7060 AUTHORIZATION TO TRANSFER AND ASSIGNMENT OF PRIVILEGE TO RENEW I/we hereby certify, that I/we _____________________________________________________ do hereby authorize the (1) transfer of my/our rights and interests in and assign my/our privileges to renew Idaho State liquor by the drink license number _________________ to ___________________________________________________________________ (2) (3) and hereby give consent to said person(s) to apply for the 20 _____ liquor license per Director Regulation 012.03. (4) IN WITNESS WHEREOF, I/we have hereunto set my/our hand(s) this _________ day of (5) _______________________, 20 ____. _______________________________________________ (Signature) (6) _______________________________________________ (Signature) (6) _______________________________________________ (Signature) (6) On this ________day of _________________________20 _____, before me, the undersigned, a notary public in and for the State of _______________, personally appeared ____________________________________________ known to me to be the person(s) whose name(s) is/are subscribed to the foregoing instrument and acknowledged to me that they executed the same. __________________________________________ Notary Public Residing at ________________________________ My Commission Expires ____________________ (7) ************************************************************************************** INSTRUCTIONS (1) Print name of most recent licensee (corporation, partnership, individual) (2) Print most recent state license number (3) Print name of new applicant corresponding to the application (4) Print year for which new applicant will be applying (5) Date of signature (6) Signature of each individual, a corporate officer, or each partner of the licensee listed on line 1 (7) Notary must complete the dates and whose signature(s) notarized, sign, and seal 12/2000 American LegalNet, Inc. www.FormsWorkflow.com