ACKNOWLEDGEMENT TRADE NAME: FORM L-101-ACK (12/2007) ACKNOWLEDGMENT Name of License Service, if applicable: E-mail Address of License Service: Mailing Address of License Service: EACH PERMITTEE OR LICENSEE SHALL HAVE EXCLUSIVE OCCUPANCY AND CONTROL OF THE ENTIRE LICENSED LOCATION. ANY ARRANGEMENT THAT SURRENDERS SUCH CONTROL OF THE EMPLOYEES, PREMISES OR BUSINESS, INCLUDING PROFITS AND LOSSES, TO PERSONS OTHER THAN THE LICENSEE OR PERMITEE IS UNLAWFUL. WARNING: Section 101.69 of the Texas Alcoholic Beverage Code states: “…a person who makes a false statement or false representation in an application for a permit or license or in a statement, report, or other instrument to be filed with the Commission and required to be sworn commits an offense punishable by imprisonment in the penitentiary for not less than 2 nor more than 10 years.” SIGN AND NOTARIZE SIGN AND NOTARIZE If Applicant is: Individual Who Must Sign: Individual Owner Partnership Partner Corporation Officer Private Clubs Only Officer Ltd. Liability Co. Ltd/Ltd Liability Partnership SIGN HERE: Before me, the undersigned authority, on this Officer or Manager General Partner day of , 20 the person whose name is signed to the foregoing application personally appeared and, duly sworn by me, states under oath that he or she has read the said application and that all the facts therein set forth are true and correct. IF ONLY APPLYING FOR A SUBORDINATE PERMIT OR LICENSE: Has there been any change in the ownership of the business since the last application was filed? PRINT NAME: YES NO SIGN HERE: Notary Public SEAL MB, LB, RM, N NL, NB, NE, P, Q, W, X, LX, G, Z, B, BP OR D PUBLISHER’S AFFIDAVIT Name of newspaper City, County Dates notice published in daily/weekly newspaper (mm/dd/yyyy) ATTACH / / TO / / PRINTED Publisher or designee certifies attached notice was published in newspaper stated on dates shown. COPY OF Signature of publisher or designee THE Sworn to and subscribed before me on this date / / NOTICE Signature of Notary Public SEAL RETAILERS AND WINERIES COMPTROLLER OF PUBLIC ACCOUNTS CERTIFICATE This is to certify on this day of , 20 , the applicant holds or has applied for and satisfies all legal requirements for the issuance of a Sales Tax Permit under the Limited Sales, Excise and Use Tax Act or the applicant as of this date is not required to hold a Sales Tax Permit. Sales Tax Permit Number: Outlet Number: Print Name/Title of Comptroller Employee: SIGN HERE: Field Office: SEAL American LegalNet, Inc. www.FormsWorkflow.com