License Transfer Request (Sign Off) {ABC-211-A}

ABC-211-A, LICENSE TRANSFER REQUEST ("SIGN OFF"), Type or print clearly in black or blue ink (do not use red). If you need more space for signatures, use Item #20. The renewal fee will be collected on any transfer application within 60 days prior to the expiration date of the transferor’s license at the discretion of the Department. The transferor should report any mailing address changes to the District Office. • This form is to be signed by transferors only. • Read instructions before completing. • All signatures must be witnessed by an ABC employee or notarized in accordance with laws of the State where signed. www.FormsWorkflow.com