Page 1 of 2 Form L-SI (05/2018) INFORMATION AND INSTRUCTIONS FOR SUCCESSOR IN INTEREST L - SI - I (0 5 /201 8 ) INSTRUCTIONS: Upon the death of a permittee who is a sole proprietor, a person who is a descendant or who has an interest in the permitor on bankruptcy, receivership or partnership dissolution must file a successor in interest to operate the business during theunexpired portion of the permit. ohaving an interest in the permit, or on bankruptcy, receivership, or partnership dissolution, the receiver orsuccessor in interest may apply to the county judge of the county where the licensed premises are located forcertification that he is the receiver or successor in interest. On certification, unless good cause for refusal is shown,the commission or administrator shall grant permission by letter or otherwise, for the receiver or successor ininterest to operate the business during the UNEXPIRED PORTION OF THE PERMIT. The permit MAY NOT BERENEWED, but the receiver or successor in interest may apply for an ORIGINAL permit or license. A receiver orsuccessor in interest operating for the unexpired portion of the permit is subject to the provisions of this coderelating to the suspoAn original application must be submitted to your local Texas Alcoholic Beverage Commission (TABC) office. Theoriginal must be submitted approximately 45 days prior to the expiration of the license/permit to avoidinterruption of the sale of alcoholic beverages. A successor in interest can only be granted as a result of bankruptcy, receivership, death or permittee or person having aninterest in the permit or partnership dissolution. It CANNOT be granted as a result of a divorce decree. MIXED BEVERAGE PERMITS ONLY: Renewal of Permit by Descendant or Surviving Spouse Mixed Beverage Permit qualifies as the successor in interest to the permit as provided in Section 11.10 of this code, thedescendant or surviving spouse may continue to renew by paying a renewal fee equal to the fee the permittee would be This application must be filed with the County Judge furnishing evidence that the successors are duly entitled to beconsidered. The affiant must complete application and submit it to the County Judge. The County Judge will complete the County Authorization of Success in Interest. The following may be required for your successor in interest application:oForm L-OP Owner of PropertyoInterview/Responsibility Courseo Each affiant indicated must sign the application and provide their full name, social security number, drivers license number,date of birth, phone number, email address and residential address. For more than one affiant make a copy of the form andcomplete the form for the additional affiant. The completed application and authorization must be filed at your local TABC office. To locate your local TABC office visitus at http://www.tabc.texas.gov/contactus/localfieldoffice.asp . American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Form L-SI (05/2018) COMPLETING FORM L-SI CURRENT PERMIT INFORMATION All information for this section can be found on the license/permit. Question 1: License/Permit No. Enter the current license/permit numberExamples:oBG123456oMB234567 Question 2: License/Permit Description Enter the license/permit descriptionExamples:ooMixed Beverage Permit Question 3: Expiration Date Enter the expiration date of the license/permit Question 4: Trade name of Location Enter the trade name of the business or the doing business as (DBA) Question 5: Location Address Enter the location address of the business. Including the street number, street name, city, county, state and zip code. Question 6: Name of Former Business Owner Enter the former name of the business ownerExamples:oJohn Smith (Sole Proprietor)oSmith & Jones (Partnership) AFFIANT INFORMATION Question 7: How do you qualify as the successor(s) in interest of the said business? Enter how you qualify as the successor(s) in interest of the business.If due to death, indicate if you are the surviving spouse or descendant. Question 8: Social Security Number (SSN), Issuing State/DL No. and Date of Birth (mm/dd/yyyy) month, day and year format. Question 9: Last Name, First Name and MI Enter your last name, first name and middle initial. Question 10: Phone No. and Email Address Enter your phone number and email address. Question 11: Residential Address Enter your residential address. Including the street number, street name, city, county, state and zip code. WARNING AND SIGNATURE Read the WARNING and print your name, sign your name and enter your title.The notary public will enter the day, month and year you appeared before them. The notary public with sign their name andstamp their seal. American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 1 Form L - SI (0 5 /201 8 ) SUCCESSOR IN INTEREST L - SI (0 5 /201 8 ) s entirely. CURRENT PERMIT INFORMATION 1. License/Permit No. 2. License/Permit Description 3. Expiration Date 4. Trade Name of Location 5. Location Address City County State Zip Code 6. Name of Former Business Owner AFFIANT INFORMATION (For more than one affiant make a copy of this form and complete) 7. How do you qualify as the successor(s) in interest of the said business? Dissolution of Partnership Bankruptcy/Receivership Death If death, indicate if: Surviving spouse Descendant 8. S ocial Security Number (S SN ) Issuing State/DL No. Date of Birth (mm/ dd/yyyy) 9. Last Name First Name MI 10. Phone No. Email Address 11. Residential Address City County State Zip Code WARNING AND SIGNATURE WARNING : representation in an application for a permit or license or in a statement, report, or other instrument to be filed with the Commission and requir ed to be sworn commits an offense punishable by imprisonment in the Texas Department of Criminal Justice for n BY SIGNING YOU ARE S WEARING TO ALL INFOR MATION AND ATTACHMEN TS TO THIS PACKET. PRINT NAME SIGN HERE TITLE Before me, the undersigned authority, on this 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. SIGN HERE NOTARY PUBLIC S E A L American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Form L - SI (0 5 /201 8 ) SUCCESSOR IN INTEREST L - SI (0 5 /201 8 ) OF SUCCESSOR IN INTEREST The State of Texas The County of: 247 247 247 I, ,County Judge of County, Texas, Do Certify: That on this day of A.D., 20 , there came on to be heard this application for Successor In Interest. I find the affiant(s ) indicated on form L - SI qualifies as the Successor(s) In Interest of this business. It is my recommendation that Name of Affiant(s) as Successor(s) In Interest until the present expires. License/Permit Number Witness My Signature and Seal of Office on this day of A.D., 20 . To certify Seal of Office Signature County Judge County, Texas Phone No. Email Address American LegalNet, Inc. www.FormsWorkFlow.com