ALL APPLICANTS TRADE NAME: 1. FORM L-101-APP (12/2007) Will the license or permit embrace the entire building, grounds, and appurtenances at the address shown as the location? 1. YES NO 2. YES NO If “NO,” attach the required diagram. 2. Will your business be located within 300 feet of a church or public hospital? NOTE: Make measurements for churches or public hospitals from front door to front door, along the property lines of the street fronts and in a direct line across intersections. INSTRUCTIONS FOR MEASUREMENTS FOR QUESTIONS 3 and 4: Make measurements for private and public schools, day care centers and day care facilities in a direct line from the nearest property line of the school, day care center or day care facility to the nearest property line of the place of business, and in a direct line across intersections. NOTE: If located in a multistory building, refer to the Instruction Booklet for detailed instructions. 3A. Will your business be located within 300 feet of any school, including private schools, day care center or day care facility? 3A. YES NO B. YES NO 4A. YES NO B. If “YES,” are the facilities located on different floors or stories of the building(s)? 4A. Will your business be located within 1,000 feet of a public school? B. B. Will your business be located within 1,000 feet of a private school? 5. YES NO 5. YES NO 6A. Will your business be located within 1,000 feet of a public or private school? YES NO If “YES,” give written notice of this application to the school officials and attach a copy of the ALL APPLICANTS notice to this application. NOTE: Make measurements from the door where the public enters your establishment to the nearest property line of a public or private school. 6A. Has any person named in question 7 on L-101-A, 7 on L-101-B, 2 on L-101-P, 2 on L-101-C, or 4 on L-101-N or his or her spouse been finally convicted or received deferred adjudication for any of the following offenses? If “YES,” indicate type of offense and attach an explanation: (1) any felony offense (8) any offense involving firearms or a deadly weapon (2) prostitution (9) more than three violations of the Texas Alcoholic (3) bookmaking Beverage Code relating to minors (4) gambling or gaming (10) violations of the Texas Alcoholic Beverage Code (5) bootlegging resulting in a criminal fine of $500 or more or (6) vagrancy offense involving moral turpitude cancellation of a license or permit (7) any offense involving dangerous drugs or (11) violations of an individual’s civil rights or controlled substances as defined in Texas discrimination against an individual on the basis or Controlled Substances Act race, color, creed or national origin B. If answer to 6A is “YES,” has it been five years since the termination of a sentence, parole or probation served for any offenses indicated above? B. YES NO If “NO,” attach an explanation. The applicant or permit and license holder may have an interest, directly or indirectly in only one level of the alcoholic beverage industry; i.e., manufacturing, wholesaling or retailing. You or your agent, servant or employee may not be employed in any capacity at different levels, may not rent or lease property or equipment from or to an entity operating at another level, may not secure credit or a loan in any form for an entity at another level, cannot control in any fashion the interests of a permittee or licensee at a different level. 7. Are you or anyone described in question 7 on L-101-A, 7 on L-101-B, 2 on L-101-P, 2 on L-101C, or 4 on L-101-N in violation of the above requirements? 7. YES NO If “YES,” attach an explanation. Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com ALL APPLICANTS CONTINUED TRADE NAME: 8. FORM L-101-APP (12/2007) List the bank name, address and account numbers to be used in connection with the proposed business. (If more space is needed, attach additional page.) Bank Name Account Name Bank Address Account No. Bank Name Account Name Bank Address Account No. 9. List name and address of the accountant/bookkeeper of the business. Enter SELF if you are doing your own bookkeeping. Name 10. Address What is the amount of total investment from all sources for this business location? $ ALL APPLICANTS Please be prepared to provide copies of all documents related to the finance of the business. 11. List any person, firm, or corporation that has advanced or will advance any money, that holds any mortgage or encumbrances against the assets of the proposed business, or that has signed or co-signed, guaranteed or financially assisted this business for which you are seeking a permit/license. If a partnership or corporation, list entity along with partners or officers. (If more space is needed, attach additional page.) Social Security or FEID No. Issuing State/Driver’s License Number Date of Birth (mm/dd/yyyy) / / Name, Corporation, Partner/Officer Amount $ Terms Social Security or FEID No. Issuing State/Driver’s License Number Date of Birth (mm/dd/yyyy) / / Name, Corporation, Partner/Officer Amount $ Terms Social Security or FEID No. Issuing State/Driver’s License Number Date of Birth (mm/dd/yyyy) / / Name, Corporation, Partner/Officer Amount $ Terms 12. Do you own the furniture, fixtures and equipment at the proposed licensed location? 12. YES NO 13. YES NO If “NO,” please list from whom you lease the items, and the amount paid. Name 13. Amount Paid $ Are you applying for a permit/license for the benefit of someone else? If “YES,” provide the following information: Name Address Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com