UBI Liquor Control Board Licensing and Regulation PO Box 43098 Olympia WA 98504-3098 www.liq.wa.gov Fax: (360) 753-2710 Liquor Control Board Addendum Non-Retail & Interstate Common Carrier Licenses This form must accompany a Master Application from the Department of Licensing, Master License Service Questions? Please call the Liquor Control Board’s customer service desk at (360) 664-1600 1. Do you have any interest, financial or otherwise, in any Washington State liquor retailer?...........................……………………………………………………………….. YES NO Do you hold any notes, mortgages, or other forms of obligation against any Washington State retail licensee?………………....................................................... YES NO 3. If married, are you or your spouse employed by any liquor retailer?........................ YES NO 4. Are you assuming a business that has a current liquor license?…………………….. YES NO YES NO YES NO YES NO YES NO YES NO YES NO 2. If yes, present licensee’s liquor license number and class of license 5. Are you closing your business and moving to a new location?....................…............ 6. Contact person for questions regarding application Mailing address Business Phone 7. ( ) Home Phone ( ) Is this premises located on: Tribal lands?......................................................................................................…...... If yes, name of tribe Federal lands?...................................................................................................…..... If yes, name of federal entity Port authority lands?..........................................................................................…..... If yes, name of port authority Automotive track?.................................................................................................….. If yes, name of track Fairground property?......................................................................................…....... If yes, name of fair authority OVER LIQ 149-52 2/99 Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com 8. List all liquor operating business names (not brand names). Attach a separate sheet if needed. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. FOR INTERSTATE COMMON CARRIER LICENSEES: 9. A. Number of duplicate common carrier licenses requested B. Name(s) to appear on duplicate licenses (if different than name on original license) LIQ 149-52 2/99 Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com