For Office Use Only UBI Liquor Control Board Licensing and Regulation 3000 Pacific Ave SE PO Box 43098 Olympia WA 98504-3098 www.liq.wa.gov For Validation Only 01P-400-925-0003 60 Day Temporary Liquor License Application $50 Fee • You may apply for a temporary liquor license if you are assuming a business that has an existing liquor license. You must be applying for the same type of license held by the current licensee. • This license allows you to operate under the current licensee’s privilege for up to 60 days. (If the current license expires within 60 days, a temporary license can only be issued for the period remaining on the current license.) • To qualify for the temporary liquor license: - All applicants must clear through a criminal history check. - All required documents for a liquor license must be turned in and reviewed (please see the publication “How to Apply for a Liquor License” for more information. - You must have a briefing on liquor laws and regulations from your local Liquor Control Agent. Current Licensee Information Trade Name Type of Liquor License Liquor License No. Expiration Date Address of Licensed Premises Street Address City State Zip + 4 On approval of the Washington State Liquor Control Board, I hereby allow and acknowledge that the applicant(s) are allowed to operate on my license and I remain responsible for any violations incurred. Date Signature of Current Licensee Name of Current Licensee (please print) Title Contact Phone Number of Current Licensee Applicant Information I understand that a misrepresentation of fact shall be deemed a lack of good faith and shall be sufficient cause for disapproval or revocation of the temporary liquor license. I further understand that issuance of this temporary liquor license does not guarantee approval of the annual license. If I have not received the annual liquor license within 60 days, I will not be eligible to sell liquor, and the current licensee will either resume the business or I will discontinue liquor sales (under certain circumstances a second 60 day temporary liquor license may be applied for). As the applicant, it is my responsibility to fully disclose all entities involved and provide appropriate documentation for issuance of an annual license. Changes to the current business will not be made while a temporary license is in effect. Date LIQ 390-50-6/03 Signature of Applicant (sole proprietor, partner, corporate, officer, or LLC member) Name of Applicant (please print) American LegalNet, Inc. www.FormsWorkflow.com