Application For Transfer Of Location Form. This is a Ohio form and can be use in Department Of Commerce Statewide.
Tags: Application For Transfer Of Location, DLC 4118, Ohio Statewide, Department Of Commerce
Ohio Department of Commerce Division of Liquor Control 6606 Tussing Road, P.O. Box 4005 Reynoldsburg, Ohio 43068-9005 For Questions call (614) 644-3156 Office Hours 8:00 a.m. - 5:00 p.m. http://www.com.ohio.gov/liqr APPLICATION FOR TRANSFER OF LOCATION OF ALL PERMIT CLASSES LISTED BELOW CAUTION: ALLOW 6 TO 8 WEEKS FOR PROCESSING. RETURN TO ADDRESS ABOVE PROCESSING FEE $100.00 PRINT OR TYPE ALL INFORMATION, EXCEPT SIGNATURES NOTE: You may NOT sell alcoholic beverages at the new location until the PERMIT(S) have been issued to you at that location. Permit Holder (Individual, Corporation, Partnership or LLC) Current Permit # PRESENT PERMIT LOCATION INFORMATION: NEW PERMIT LOCATION INFORMATION: DBA (doing business as): DBA (doing business as): Permit Premises Address: Permit Premises Address: Township (If outside City Limits): State City: Township (If outside City Limits): County: OH Attorney's Name: Zip Code: County: State City: OH Zip Code: Phone # Address: Mailing Address: (Name, Street Address, City & Zip): CHECK Classes of Permit(s) Being Transferred: A-1 A-1A A-2 A-3 A-4 B-1 B-2 B-2A B-3 B-4 B-5 C-1 C-2 C-2X D-1 D-2 D-2X D-3 D-3A D-3X D-4 D-5 D-5J* D-6 D-7 G I S W *Only within the boundaries of the Community Entertainment District ("CED") Data Entry Initials: ________________ FOR DIVISION USE ONLY CODER FOR PRESENT LOCATION Data Entry Action: Proc. Fee Pd: RECEIPT NUMBER YES Comments/Notes: NO OLD TAXING DISTRICT OLD PERMIT # NEW TAXING DISTRICT NEW LOCATION PERMIT # DLC4118 EOE/ADA SERVICE PROVIDER Page 1 FOR TTY USERS DIAL ORS 1-800-750-0750 Rev. 09/2010 American LegalNet, Inc. www.FormsWorkFlow.com 1. Do you own the real estate on which the proposed business will be located? If NO, return a completed a signed and dated copy of your LEASE OR RENTAL CONTRACT, OR SUMMARY OF TENANCY RIGHTS form (DLC form 4085). YES NO 2. Will the applicant be the sole owner of the business and equipment? If NO, and the fixtures or equipment are rented, submit signed and dated copy of rental agreement. YES NO YES NO YES NO YES NO 3. Will any person, partnership, LLC, or corporation, excluding banks or building and loan associations, have ANY financial interest (such as money, loans, installment contracts, property or other interest) or share in the profits in your business or your property, real or personal? If YES, attach an affidavit with details. NOTE: Ohio Revised Code Section 4303.293 provides a criminal penalty for failure to answer this question completely and correctly. 4. Is there an existing building? If NO, give approximate date construction will begin: ________________________________ 5. Are you applying to transfer all the permit classes being used at your present location to the proposed location? If NO, attach a written explanation for not doing so. DELIBERATE MISREPRESENTATION OF ANY OF THE INFORMATION ON THE APPLICATION CAN RESULT IN THE DIVISION'S REFUSING TO APPROVE THIS APPLICATION. State of Ohio, ____________________County, ss I, _____________________________________________being first duly sworn, according to law, depose and say that the (Please Print) statements and answers made in the foregoing application are true. X____________________________________________________________________ _____________________ ________ (Signature of Individual, Partner, Officer, Managing Member, or 5% or more Stockholder or Member) (Title) (Date) ______________________________________ ______________________ ________ (Residence Address) (City) _____________ _______________________ (State) (Zip Code) (Area Code & Phone Number) (To be completed by NotaryPublic) Sworn to before me and subscribed in my presence this __________day of _______________________________, 20 _____________. ________________________________________ (Notary Public) _______________ (Notary Expiration) Page 2 American LegalNet, Inc. www.FormsWorkFlow.com REQUIRED DOCUMENTS FOR ACCEPTANCE OF A TRANSFER OF LOCATION APPLICATION Please use the list below to check off all items as you complete them, to submit with the application packet CAUTION: ALLOW 6 TO 8 WEEKS FOR PROCESSING. REQUIRED FOR ALL TYPES OF ENTITIES Application must be completed in full, all questions answered, signed, and notarized. Application: Application Processing Fee: $100.00 - Check made payable to Division of Liquor Control. Background Check: PLEASE READ "BACKGROUND CHECK INFORMATION" DLC4191 Personal History Background Form (DLC4121): Section A. ONLY must be completed in full for each stockholder or officer for whom a background check will be performed by the Ohio Bureau of Identification and Investigation (BCI&I). Submit copy of signed and dated lease, tenacy agreement, or may submit DLC Form 4085 "Summary of Tenancy Rights" completed in full. Lease or Tenancy Agreement: REQUIRED DOCUMENTS TO BE FILED WITH INDIVIDUALS ONLY See list above "Required for All Types of Entities". No other documents are needed, unless requested during processing. REQUIRED DOCUMENT TO BE FILED WITH NON PROFIT ENTITIES 4029 Form: To be filed with Governmental or Educational entities, or other non-profit businesses. Form must be completed in full. List the top five officer, including social security numbers. This form must be notarized. REQUIRED DOCUMENTS TO BE FILED WITH CORPORATIONS ONLY 4030 Form (Corporation): Form must be completed in full. List the top five officers, including social security numbers. Indicate all stock holders over 5% including social security numbers. Indicate total shares issued. Must be notarized. Certificate of Good Standing From the Secretary of State: If not incorporated in the State of Ohio, submit a copy of CERTIFICATE OF AUTHORITY TO DO BUSINESS IN OHIO, issued by the Ohio Secretary of State. If corporation is nonprofit, submit a Certificate of CONTINUED EXISTENCE from the Ohio Secretary of State. Ohio Secretary of State: (614) 466-3910 or 1-877-767-3453 - www.sos.state.oh.us REQUIRED DOCUMENTS TO BE FILED WITH PARTNERSHIPS 4031 Form (Partnership): Form must be completed in full. Indicate all partners including social security and/or Tax ID numbers. Limited Partnerships need only indicate general partners. Must be notarized. REQUIRED DOCUMENTS TO BE FILED WITH LIMITED LIABILITY COMPANIES 4032 Form (LLC): Form must be completed in full, indicating all members with 5% or more membership or voting interest, all managing members, and officers, if applicable, including social security numbers. Must be notarized. Certificate of Organization from the Secretary of State: Ohio Secretary of State: (614) 466-3910 or 1-877-767-3453 www.sos.state.oh.us GENERAL INSTRUCTIONS FOR FILING TRANSFER OF LOCATION CAUTION: ALLOW 6 TO 8 WEEKS FOR PROCESSING 1. A RENEWAL application must be filed, for the PRESENT LOCATION, at least fifteen (15) days before the current permit's expiration date. 2. If the NEW location is in a political subdivision different from the present permit location, check the quota availability of permits by calling or writing to the Division of Liquor Control, as the issuance of all permits is subject to existence of an opening under the quota. 3. On the application form, mark the classes being transferred. Give the current permit number and expiration date. Return the application, all fees, and all required documents to: OHIO DEPARTMENT OF COMMERCE - DIVISION OF LIQUOR CONTROL, 6606 TUSSING ROAD, P.O. BOX 4005 REYNOLDSBURG, OHIO 43068-9005 WARNING: NO permit will be issued until the proposed business is ready for operation and meets Division regulations. All construction or remodelling costs are at the applicant's risk, as the Division cannot guarantee the transfer of this license. Issuance of all permits are subject to WET or DRY status of location. Page 3 American LegalNet, Inc. www.FormsWorkFlow.com