Liquor License: ____________________________ Trade Name: __________________________ UBI # _____________________________ Limited Partnership Information Form Name of Limited Partnership: Date of Formation: State of Formation Telephone No.: ( ) Limited Partnership Address: General Partner: Name: % owned Address: Limited Partners with more than 10% ownership Name Address Date of Birth Social Security # % Owned Partner #1 Spouse of the above Partner #2 Spouse of the above Partner #3 Spouse of the above Partner #4 Spouse of the above Partner #5 Spouse of the above Please attach a list of names and % of ownership for all limited partners and their spouses’ owning 10% or less. Certification I certify under penalty of perjury the information disclosed is true, correct and complete in this document and all additional attachments regarding the limited partnership. Print Name: ____________________________________________________ Signature: ______________________________________________________ Date: ____________________ LIQ 880-50-4/07 American LegalNet, Inc. www.FormsWorkflow.com