Application For Transfer Of Licenses For Sale Of Fermented Malt Beverages And Or Intoxicating Liquor From One Premises To Another
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Application For Transfer Of Licenses For Sale Of Fermented Malt Beverages And Or Intoxicating Liquor From One Premises To Another Form. This is a Wisconsin form and can be use in Department Of Revenue Statewide.
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Tags: Application For Transfer Of Licenses For Sale Of Fermented Malt Beverages And Or Intoxicating Liquor From One Premises To Another, AT-112, Wisconsin Statewide, Department Of Revenue
RETAIL LICENSE TRANSFER – PREMISES TO PREMISES
FEE $
Wisconsin Department of Revenue
APPLICATION FOR TRANSFER OF LICENSES FOR SALE OF FERMENTED MALT BEVERAGES
AND/OR INTOXICATING LIQUOR FROM ONE PREMISES TO ANOTHER
, Wisconsin
, 20
To the governing body of the
City
County of
Village
Town
of
Wisconsin.
The undersigned hereby applies for a transfer of Class
license from
to
(present location)
on or about
(proposed location)
.
(date)
1.
APPLICANT: (print name and address plainly)
(a)
(b)
2.
Full name of applicant
Address
LOCATION AND DESCRIPTION OF PREMISES TO WHICH APPLICATION FOR TRANSFER IS MADE:
Describe building or buildings where alcohol beverages are to be sold, served and stored.
(a)
Street number
(b)
Trade name of establishment
(c)
Physical description of building, buildings and/or land area comprising licensed premises.
(d)
Legal description (omit if street address is given above.)
(e)
Is any other business conducted on same premises?
(f)
Was this location licensed for beer or liquor during the past year?
(g)
Give name and address of previous licensee.
(h)
Will the previous licensee surrender its license?
AT-112 (R. 4-09)
Yes
Yes
No
If so, what?
Yes
No
No
Wisconsin Department of Revenue
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ALL APPLICANTS FOR TRANSFER OF CLASS B LICENSES MUST ANSWER THE FOLLOWING:
3.
If granted, state any interest, directly or indirectly, that any brewer, bottler, wholesaler, manufacturer, or
rectifier will hold in the premises for which you are applying
4.
If you do not own the fixtures, state the manner, terms and conditions under which said fixtures are held
State of Wisconsin
County of
}
(Signature)
ss.
(I) (We),
and
being first duly sworn on oath says that (he/she is) (they are) the person(s) above named and that the answers
to the questions in each instance are complete and true.
Subscribed and sworn to before me this
day of
, 20
Notary Public,
County, Wis.
Date
Date
Approved
Denied
Submitted to Council or Board
Filed
Treasurer’s Receipt No.
License No.
Ward
Proposed Location
Ward
Original Location
Name
CLASS OF BUSINESS
My Commission Expires
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