O n Premise Transfer Application Rev. 6/201 8 Page 1 Replace 6/2017 Bureau of Alcoholic Beverages Division of Liquor Licensing & Enforcement 8 State House Station Augusta, ME 04333 - 0008 Tel: (207) 624 - 7220 Fax: (207) 2 87 - 3434 Email inquiries: MaineLiquor@Maine.gov ON PREMISE TRANSFER APPLICATION The undersigned, who is the holder of an O n Premise Liquor License under the provisions of Title 28 - A MRSA 247 605, hereby respectfully requests that said license be transferred from the present loca tion: FROM: Current Physical Address TO: New Physical Address Both premises being within the sa me municipality of: City/Town Requested Transfer Date : Permanent License # : Expiration Date : Name of Business : Doing Business as: Contact Person : Telephone Number : Email address: ( Please Print ) Has the premises for which the transfer is requested been licensed by the Department of Human Services? Yes No How many feet to the nearest school, school dormitory, church, chapel or parish house ? Which of the above is nearest? Permanent License # : Expiration Date : Dated at : On , 20 City/Town, State Date Signatu re of Individual(s), or Duly Authorized Officer(s) of (Printed name(s) Corporation, or if Partnership, by Members of Partnership American LegalNet, Inc. www.FormsWorkFlow.com On Premise Transfer Application Rev. 6/2018 Page 2 Replace 6/2017 TO STATE OF MAINE MUNICIPAL OFFICERS & COUNTY COMMISSIONERS: Hereby certify that we have complied with Section 653 of Title 28 - A Maine Revised Statutes and hereby approve said application. Dated at: , Maine City/Town (County) On: Date The undersigned being: Municipal Officers County Commissioners of the City Town Plantation Unincorporated Place of: , Maine Hereby certify that we have given public notice on this application and held public hearing thereon as required by Section 653 Title 28A, Maine Revised Statutes and herby approve said application. Signature of Official(s) Printed name of Official(s) THIS APPROVAL EXPIRERS IN 60 DAYS American LegalNet, Inc. www.FormsWorkFlow.com