L-BRCI (0/201) Business Packet for Reporting Changes The Business Packet for Reporting Changes (L-BRC) must be completed if there has been any change within your current business structure or applying for a change of class. This packet includes the following forms: L-C (Corporation, Trust, City, County or University)L-LLC (Limited Liability Company)L-P (Partnership)L-PHS (Personal History Sheet) 226 For any new officer, director, manager or majoritystockholder/member/partner to your entity. Note: This form (L-PHS) is not required forholders of an S, U, BS and DS. Submit your completed packet to your local TABC office. To find your local office access our website at www.tabc.texas.gov/contactus/localfieldoffice.asp If you are a holder of an S, U, BS or DS, submit your application directly to TABC, PO Box 13127 Austin TX 78711-3127. For questions and/or assistance contact licensing@tabc.texas.gov or by phone at 512-206-3360. Type of Change: Officers, Manager, Director, Stockholder, Member or Trustee/Beneficiary: Depending on your business type, complete any/all of the following: L-BRC, L-C, L-LLC and/or L-P. A completebusiness structure must be disclosed on these forms. Personal history sheets (L-PHS) must becompleted for any new officer, director, manager or majority stockholder/member/partner to yourentity. Change of Business Entity: Complete the entire Business Packet for Reporting Changes (L-BRC, L-C, L-LLC and/or L-P) for each location affected by the change. TABC requires 10 days priornotice of the change. A Personal History Sheet(s) (L-PHS) for each new individual to your entity anda $100.00 fee will be required for each location. Review Section 11.12, of the Texas AlcoholicBeverage Code, for qualification and additional requirements. Your current License/Permit will needto be submitted with your application. Merger: Complete entire Business Packet for Reporting Changes (L-BRC, L-C, L-LLC and/or L-P), The merger must be reported within 10 days of the occurrence, a $100.00 fee per each location, andan affidavit including all tradenames and locations with license/permit numbers affected must beincluded. Complete Personal History Sheets (L-PHS) for new individuals to your entity. Your currentLicense/Permit will need to be submitted with your application. Conversion: Complete the entire Business Packet for Reporting Changes (L-BRC, L-C, L-LLC and/or L-P), attach the certificate of conversion, and an affidavit including all tradenames andlocations with license/permit numbers. Complete Personal History Sheets (L-PHS) for newindividuals to your entity. Your current License/Permit will need to be submitted with your application. Change of Class (for change of class only): Complete form (L-BRC) pages 1 and 2 (that apply to your change) and submit any fees required. Your current License/Permit will need to be submittedwith your application. Consolidation (Package Store Only): Complete the entire Business Packet for Reporting Changes (L-BRC, L-C, LLC, and/or L-P), attach the letter of intent to consolidate (consanguinity letter) and aPersonal History Sheet (L-PHS) must be completed for new individuals to your entity. American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 2 Form L-BRC (0/201) BUSINESS PACKET for REPORTING CHANGES L-BRC(0/201) You must complete the entire Business Packet for Reporting Changes according to your changes as outlined on the instruction sheet (L-BRCI). Select appropriate entity pages. Personal history sheets (L-PHS) must be completed for any new officer, director, manager or majority stockholder/member/partner. All statutory references mentioned in this application refer to and can be found in the Texas Alcoholic Beverage Code located on our website. www. tabc.texas.gov/laws/codeandrules.asp INDICATE ALL CHANGE(S) YOU ARE REPORTING WITH THIS APPLICATION 1. Current License/Permit No. 2. Contact Phone Number 3. Email Address 4 . Type of Change Officer, Manager, Director, Stockhol der, Member Merger Partner (limited or general) Conversion Trustee/Beneficiary Consolidation (Package Store Only) Change of Business Entity Other .Effective Date of above change (MM/DD/YYYY) .Are you applying for a change of class? Yes No If 223YES,224 indicate type of change: FROM Wine and Beer Retailer222s Permit (BG) TO Wine and Beer Ret ailer222s Off - Premise Permit (BQ) FROM Beer Retailer222s On - Premise License (BE) TO Beer Retailer222s Off - Premise License (BF) OWNER INFORMATION .Owner of Business on Current License/Permit .Federal Employer Identification No. (FEIN) OWNER INFORMATION (ONLY FOR CHANGE OF BUSINESS ENTITY, MERGER, AND CONVERSION) .Type of Owner Individual Partnership City/County/University Other Corporation Limited Partnership Joint Venture Limited Liability Company Limited Liability Partnership Trust BUSINESS INFORMATION .Has any person listed in this Business Packet, or his or her spouse, been finally convicted or received deferred adjudication for any of the following offenses? Yes No If 223YES,224 indicate type of offense and attach an explanation: any felony offense prostitution bookmaking gambling or gaming bootlegging vagrancy offense involving moral turpitude any offens e involving dangerous drugs , synthetic cannabinoids or controlled substances as defined in Texas Controlled Substances Act any offense involving firearms or a deadly weapon more than three violations of the Texas Alc oholic Beverage Code relating to minors violations of the Texas Alcoholic Beverage Code resulting in a criminal fine of $500 violations of an individual222s civil rights or discrimination against an individual on the basis or race, color, creed or national origin If 223YES,224 has it been five years since the termination of a sentence, parole or probation served for any offenses indicated above ? Yes No If 223NO,224 attach an explanation. .Has any person listed in this Business Packet, or his or her spouse, had a cancellation of a license or permit in the past five years? Yes No If 223YES,224 attach an explanation. American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Form L-BRC (0/201) The applicant, license/permit holder, agent, servant or employee may not directly or indirectly have any overlapping ownerships or other prohibited relationship s (including unfair competition and unlawful trade practices) between those engaged in the alcoholic beverage industry at different levels, that is, between a manufacturer and a wholesaler or retailer, or between a wholesaler and a retailer, as the words "wholesaler," "retailer," and "manufacturer" are ordinarily used and understood, regardless of the specific names given a license\permit. Reference Chapter 102 et seq. 1.Is any person, involved in this application, in violation of the above requirements? Yes No If 223YES,224 attach an explanation. COMPTROLLER OF PUBLIC ACCOUNTS CERTIFICATE (FOR CHANGE OF ENTITY ONLY) 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 of Comptroller Employee Print Title of Comptroller Employee SIGN HERE FIELD OFFICE S E A L WARNING AND SIGNATURE If Applicant Is/Must Sign Individual/Individual Owner Corporation/Officer Partnership/Partner Limited Liability Company/ Officer or Manager Limited Partnership/General Partner EACH LICENSEE OR PERMITTEE SHALL HAVE EXCLUSIVE OCCUPANCY AND CONTROL OF THE ENTIRE LICENSED LOCATION WITH RESPECT TO SALE OF ALCOHOLIC BEVERAGES. ANY ARRANGEMENT THAT SURRENDERS SUCH CONTROL OF THE EMPLOYEES, PREMISES OR BUSINESS, INCLUDING PROFITS AND LOSSES, TO PERSONS OTHER THAN THE LICENSEE OR PERMITTEE IS UNLAWFUL. WARNING: Section 101.69 of the Texas Alcoholic Beverage Code states: 223205a 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 Texas Department