Licensing and Regulation PO Box 43098 Olympia WA 98504-3098 www.liq.wa.gov Phone: (360) 664-1600 Fax: (360) 753-2710 Grocery Store and Beer/Wine Specialty Shop Inventory Acknowledgment Trade Name License No. I understand that under current statutes that I stock and maintain the following inventory on the licensed premises (check one box only): Grocery Store - A minimum $3,000 wholesale value of food products for human consumption, not to include soda pop, beer, or wine (RCW 66.24.360). Beer and/or Wine Specialty Shop - A minimum $3,000 wholesale value of beer and/or wine (RCW 66.24.371). Estimate of cost to purchase inventory: Print Name Signature of Licensee/Applicant Date LIQ 295-50 3/00 American LegalNet, Inc. www.FormsWorkflow.com