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Outline Of Costs Form. This is a Washington form and can be use in Liquor Control Board Statewide.
Tags: Outline Of Costs, LIQ 823-50, Washington Statewide, Liquor Control Board
Licensing and Regulation Division
PO Box 43098
Olympia WA 98504-3098
360/664-1600
FAX 360/753-2710
www.liq.wa.gov
License No _________________________________
Trade Name ________________________________
UBI No _____________________________________
OUTLINE OF COSTS
Please complete the Outline of Costs stating ALL FUNDS used for your current application.
(If you are making a change to your current business that already has a liquor license, state only the funds needed
for this change to your business.)
Real property purchase amount or lease rental
(plus deposit if applicable)
$________________
Business purchase cost (Purchase & Sale Agreement normally
includes trade name, good will, equipment, inventory,
corporate stock or LLC units
$________________
Costs of opening a new business (equipment, furniture, inventory)
or COST TO CHANGE YOUR CURRENTLY LICENSED BUSINESS
$________________
Remodeling/leasehold improvements/construction
$________________
Miscellaneous fees (such as license/gambling, legal, architectural,
$________________
health/city/county permits, opening and closing costs, working capital, etc)
GRAND TOTAL of costs
$________________*
* This total should equal the sum of ALL Source
of Funds forms completed for this application
CERTIFICATION
I certify under penalty of perjury that all answers and statements are true, correct and complete. I
understand that untruthful or misleading answers are cause for rejection of my application and/or
revocation of any license granted. I hereby authorize investigation of my criminal history, financial
records and other sources as necessary for licensing.
PRINT NAME _______________________________________________________
SIGNATURE __________________________________________________________________ DATE __________________
LIQ 823-50-7/07
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