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Tied House Statement - Retail Form. This is a Washington form and can be use in Liquor Control Board Statewide.
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Tags: Tied House Statement - Retail, LIQ 186-50, Washington Statewide, Liquor Control Board
Liquor Control Board
Licensing and Regulation
PO Box 43098
Olympia WA 98504-3098
Phone: (360) 664-1600
Fax: (360) 753-2710
Tied House Statement – 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 business that manufactures, imports or distributes
alcoholic beverages. I have no ownership in any brewery, microbrewery, winery, distillery, or other liquor
supplier.
•
I have no ownership, stock* or investment in any manufacturer, importer, or distributor of alcoholic
beverages including any brewery, microbrewery, winery, distillery, or other liquor supplier.
•
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 manufacturer, importer, or distributor of alcoholic beverages,
nor have they any ownership, stock* or investment in any brewery, microbrewery, winery, distributor,
distillery, or liquor supplier.
•
I have not, nor has any officer, investor, or entity with an ownership interest in the business I am licensing
received, directly or indirectly, any money, financial assistance, advertising, sponsorship or promotion fees
from any manufacturer, importer or distributor, of alcoholic beverages.
•
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, promotion, or trademark agreement, arrangement or contract
with any manufacturer, importer or distributor 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
receives any money from any manufacturer, importer, or distributor of alcoholic beverages, nor has any
subsidiary, affiliated, or parent company of the business I am licensing entered into any oral, written,
advertising, promotion or trademark agreement, arrangement, or contract with any manufacturer, importer,
or distributor of alcoholic beverages that is prohibited by RCW 66.28.010.
•
I have not rented any real property from a landlord who manufactures, imports or distributes alcoholic
beverages. If the business I am licensing will be a spirits, beer, wine restaurant it may be leased from and
located on the premises of a licensed brewery, microbrewery, 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
retailer 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 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 186-50-6/04
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