Ohio Department of Commerce - Division of Liquor Control 6606 Tussing Road, P.O. Box 4005 Reynoldsburg, Ohio 43068-9005 http://www.com.ohio.gov/liqr For Questions call (614) 644-2496 Office hours 8:00 a.m. to 5:00 p.m. TRANSFER EXEMPT PERMIT APPLICATION TO AN ECONOMIC DEVELOPMENT PROJECT Ohio Revised Code 4303.29 allows for the transfer of location or the transfer of ownership and location of a C-1, C-2, D-1, D-2, D-3, or D-5 permit from a municipal corporation or the unincorporated area of a township in which the number of permits of that class exceeds the number of such permits authorized to be issued under the permit quota to an economic development project located in another municipal corporation or the unincorporated area of another township in which no additional permits of that class may be issued to the applicant under the permit quota, but the transfer of location or transfer of ownership and location of the permit may occur only if the applicant notifies the municipal corporation or township to which the location of the permit will be transferred regarding the transfer and that municipal corporation or township acknowledges in writing to the Division of Liquor Control, at the time the application for the transfer of location or transfer of ownership and location of the permit is filed, that the transfer will be to an economic development project. The applicant is eligible to apply for and receive the transfer of location of the permit under this section if all permits of that class that may be issued under the permit quota in the applicable municipal corporation or unincorporated area of the township have already been issued, or if the number of applications filed for permits of that class in that municipal corporation or the unincorporated area of that township exceed the number of permits of that class that may be issued under the permit quota. A permit may be transferred to a different owner at the same location, or to the same owner or a different owner at a different location in the same municipal corporation or in the unincorporated area of the same township, as long as the same or new location meets the economic development project criteria set forth in this section. GENERAL INFORMATION The applicant will be required to submit a transfer of ownership, location or transfer of ownership and location application along with the appropriate fee for the transfer of this permit. Please refer to the general instuctions for filing a transfer of ownership/location application and submit DLC Form 4120 or DLC Form 4118 (Transfer of Location only). PRINT OR TYPE ALL INFORMATION, EXCEPT SIGNATURES Current Permit Holder (Sellers) - (Individual, Corp., LLC or Partnership) Buyers (s) - (Individual, Corp., LLC or Partnership) Permit Certificate # DBA DBA Premises Address Proposed Premises Address Township (if outside city or village limits) County Township (if outside city or village limits) City & Zip Code County City & Zip Code CIRCLE Classes of Permit(s) Being Transferred: C-1 DLC 4244 C-2 C-2X D-1 D-2 D-2X D-3 D-3A D-5 D-6 Rev. 7-10-07 American LegalNet, Inc. www.FormsWorkflow.com ALL APPLICANTS MUST SUBMIT SUPPORTING DOCUMENTS FROM EACH OF THE FOLLOWING SIX AREAS WHICH MAY INCLUDE BUT ARE NOT LIMITED TO ITEMS FROM THE FOLLOWING LIST: THE FOLLOWING FACTORS SHALL BE USED TO DETERMINE THE DESIGNATION OF AN ECONOMIC DEVELOPMENT PROJECT: A. ARCHITECTURAL & PROJECT CERTIFICATIONS: (Documents must be certified by proper licensed authorities if certification is available) * Summary of costs for new construction or renovation of the project * Land costs * Copies of any resolutions or letters of endorsement from the local legislative authorities and/or Development Department or Commission * Copy of building permit * Square footage of building * Summary of contractors involved * Lease or proposed lease or proof of ownership * Personal property assets in project * Other improvements to property * Amount and certification of insurance on real and personal property * Endorsement from the local city government as an Economic Development Project B. NEW JOBS TO BE CREATED BY PROJECT: * Salary breakdown of employees by category C. PROJECTED EARNINGS OF PROJECT: * Description of business * Projected profit and loss summary for two years * Projected percentage of alcohol sales versus the sale of food or other goods and services D. PROJECTED TAX AND OTHER REVENUES ASSOCIATED WITH THE BUSINESS: * All estimated tax revenues generated by business (yearly) identified separately - Sales - Employment - including unemployment compensation, state withholding tax - Property * Secondary revenue created by business - Outside vendor contracts and services involved, (i.e., Laundry Services, Food Services, etc.) E. FINANCIAL INVESTMENT & SUMMARY: * Current Financial position of existing business - Profit & loss history of the past 2 years * Summary for new business - Itemized listing of capital needed to set up economic development project - Certification from financial institutions and other agencies evidencing intent to finance and develop this project - Projected profit & loss for first two years F. OTHER: * Disclosure of any convictions, bankruptcy or pending legal suits PLEASE ATTACH ALL DOCUMENTATION LISTING EACH DOCUMENT BY CATEGORY. THIS INFORMATION SHOULD BE LISTED SEPARATE FROM THE DOCUMENTS REQUIRED FOR PROCESSING THE TRANSFER APPLICATION. FAILURE TO DOCUMENT ALL FACTORS TO BE USED TO DETERMINE THE DESIGNATION OF AN ECONOMIC DEVELOPMENT PROJECT MAY RESULT IN THE DENIAL OF YOUR TRANSFER The undersigned certifies that all the information provided with this application is complete and accurate to the best of his/her knowledge. ___________________________________________________ Print or Type Name ______________________________________________ Authorized Signature Title ___________________________________________________ Corporate or Partnership Name (if applicable) ______________________________________________ Date American LegalNet, Inc. www.FormsWorkflow.com