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Tied House Statement - Non-Retail Form. This is a Washington form and can be use in Liquor Control Board Statewide.
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Tags: Tied House Statement - Non-Retail, LIQ 715-50, 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 ________________________________________
Tied House Statement – Non-retail
Trade Name__________________________ License No. _________________
I understand under the provisions of RCW 66.28.010:
•
I have no financial interest, directly or indirectly, in any retailer of alcoholic beverages in
Washington State.
•
I have no ownership, stock* or investment in any retailer of alcoholic beverages in Washington
State.
•
No person, officer, investor, or entity with an ownership interest in the business I am licensing
has any financial interest, directly or indirectly, in any retailer of alcoholic beverages in
Washington State, nor have they any stock* or investment in any retailer of alcoholic
beverages in Washington State.
I have not, nor has any officer, investor, or entity with an ownership interest in the business I
am licensing provided, directly or indirectly, any money, financial assistance, advertising, and
sponsorship or promotion fees to any retailer of alcoholic beverages in Washington State.
•
•
I have not, nor has any officer, investor, or entity with an ownership interest in the business I
am licensing entered into any oral or written advertising, sponsorship, promotion, or trademark
agreement, arrangement, or contract with any retailer of alcoholic beverages prohibited by
RCW 66.28.010.
•
No subsidiary, affiliated, or parent company of the business I am licensing has any financial
interest in or provides any money directly or indirectly to any retailer of alcoholic beverages.
No subsidiary, affiliated, or parent company of the business I am licensing has entered into
any oral or written, advertising, sponsorship, promotion or trademark agreement, arrangement
or contract with any retailer of alcoholic beverages prohibited by RCW 66.28.010.
•
I have not nor has any officer, investor, or entity with an ownership interest in the business I
am licensing leased property to any retailer of alcoholic beverages, except property leased to
licensed spirits, beer, wine restaurants located on the same or contiguous property of my
Washington licensed brewery, winery or distillery.
•
I understand the restrictions of RCW 66.28.010 remain in effect as long as I am a party of
interest in a manufacturer, importer, or distributor of alcoholic beverages.
*Unless the stock is held in a mutual or retirement fund in which I have no controlling or voting interest.
By signing this form I acknowledge my understanding of the above and that any violation of
this statement is cause for denial of a license or revocation of any liquor licenses currently
held.
Print Name
Title
Signature of sole proprietor, partner, officer,
stockholder, LLC member
Date
LIQ 715-50-12/05
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