Illinois Liquor Control Commission Application for Change of Business Name, Corporate Name, Address, IBT#, Business Type, or Special Event Information Duplicate License Fee $12.00 Duplicate License Fee for License Over $200 $24.00 I am the owner of an alcohol beverage business located at the address listed below. I have changed the name, corporate name, the address of my business, IBT (sales tax number), business type or my special event information as indicated. CURRENT BUSINESS INFORMATION Current State of Illinois Liquor License Number__________________________________________________ Current Applicant or Corporate Name__________________________________________________________ Currently Doing Business As (DBA) ____________________________________________________________ Current IBT# (Sales Tax number)______________________________________________________________ Retail Type (Check one) ON PREMISE OFF PREMISE COMBINED OLD Event Dates & Times ____________________________________________________________________ Premise Address_____________________________________________________________________________ City/State/Zip Code__________________________________________________________________________ NEW BUSINESS INFORMATION State of Illinois Liquor License Number_________________________________________________________ Applicant or Corporate Name_________________________________________________________________ Doing Business As (DBA) _____________________________________________________________________ IBT# (Sales Tax number)_____________________________________________________________________ Retail Type (Check one) ON PREMISE OFF PREMISE COMBINED NEW Event Date, Time or Location_____________________________________________________________ Premise Address_____________________________________________________________________________ City/State/Zip Code__________________________________________________________________________ I, undersigned applicant or authorized agent thereof, swear or affirm that the matters stated in the foregoing application are true and correct, are made upon my personal knowledge and information, are made for the purpose of requesting the State of Illinois to issue the duplicate license applied for and that the applicant is qualified and eligible to obtain the license applied for. Further, if I am a licensed Illinois Liquor Retailer, I have received local licensing authority approval prior to submitting this application. Signature of Applicant:__________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com If you are changing and fee: 1. 2. 3. 4. A copy of your Certificate of Registration from the Illinois Department of Revenue with the corrected Corporate Name A copy of your Articles of Amendment from the Secretary of State’s office A copy of your local license with the corrected corporate name A copy of your State of Illinois Liquor License If you are changing fee: 1. 2. the corporate name, you must submit the following with your application the DBA name, you must submit the following with your application and A copy of your local license with the corrected DBA name A copy of your State of Illinois Liquor License If you are changing your your application and fee: 1. 2. 3. IBT# (sales tax number), you must submit the following with A copy of your Certificate of Registration from the Illinois Department of Revenue with the corrected number A copy of an official document from Internal Revenue Service with your FEIN# A copy of your State of Illinois Liquor License **Please note that if your FEIN# is changing due to the change of the IBT#, you must apply as new using the Retailers Application. If you are changing application and fee: 1. 2. A copy of you local license with the correct address A copy of your State of Illinois Liquor License If you are changing application and fee: 1. 2. the premise address, you must submit the following with your the Type of Liquor License, you must submit the following with your A letter from the local stating whether the business is on premise, off premise or combined A copy of your State of Illinois Liquor License Note: The type describes the manner in which you sell alcoholic beverages to consumers. “On-Premise” – (patrons consumer alcoholic beverages on premise only) “Off-Premise” – (carry-out purchases only) “Combined” – (both on-premise consumption and carry-outs) If you are changing the original special event must submit the following with your application and fee: 1. 2. date, location &/or time, you A new local license with the change of date, location &/or time A new Certificate of insurance with the corrected with the updated date, location &/or times Please submit your application, fee and the necessary documentation to one of the following addresses: Illinois Liquor Control Commission 100 W Randolph St. Suite 7-801 Chicago, IL 60601 312/814-2206 or Illinois Liquor Control Commission 101 W Jefferson 3-525 Springfield, IL 62704 217/782-2136 American LegalNet, Inc. www.FormsWorkflow.com