ABC Notice Surrender of Lic. Rev. 04/08/08 Commonwealth of Kentucky Office of Alcoholic Beverage Control 1003 Twilight Trail Frankfort, Kentucky 40601-8400 Phone (502) 564-4850 Fax (502) 564-1442 NOTICE OF SURRENDER OF RETAIL LIQUOR LICENSE I am the owner or an officer of the corporation owning the retail______________ liquor license number __________________________________. I do not wish to pay the state annual renewal fee for this license and I hereby surrender said license. I understand that by doing so I relinquish all rights and claims to this license privilege issued for the premises located at________________________________________ in _______________________and the county of _______________________, Kentucky. Signature _________________________________ Print Your Name____________________________ Address of Premises ________________________ City of ____________________________________ County___________________________ Kentucky. PLEASE ATTACH YOUR LICENSE AND RETURN IT ALONG WITH THIS FORM TO OUR OFFICE. American LegalNet, Inc. www.FormsWorkflow.com