Business Packet {L-B}

Page 1 of 2 Form L-B (/201) BUSINESS PACKET L-B (/201) You must complete the entire Business Packet including all necessary ownership information and personal history sheets. Select the entity page(s) that coincides with your business structure. All officers, directors, stockholders, trustees, and beneficiaries holding ownership in this business must be disclosed. L-C (Corporation, Trust, City, County or University) L-LLC (Limited Liability Company) L-P (Partnership) L-PHS (Personal History Sheet) If you are applying as an individual, you will submit this page and the L-PHS (Personal History Sheet). OWNER INFORMATION 1. Type of Owner Individual Limited Partnership City /County/ University Corporat ion Limited Liability Partnership Other Limited Liability Company Trust Partnership Joint Venture 2. Business Owner /Applicant 3. Federal Employer Identification No. (FEIN) 4. Email Address BUSINESS INFORMATION 5 . Has any person listed in this Business Packet, or his or her spouse, been finally convicted or received deferred adjudication for any of the following offenses? Yes No If 223YES,224 indicate type of offense and attach an explanation : any felony offense prostitution bookmaking gambling or gaming bootlegging vagrancy offense involving moral turpitude any offense involving dangerous drugs or controlled substances as defined in Texas Controlled Substances Act any offense involving firearms or a deadly weapon more than three violations of the Texas Alcoholic Beverage Code relating to minors violations of the Texas Alcoholic Beverage Code resulting in a criminal fine of $500 violations of an individual222s civil rights or discrimination against an individual on the basis of race, color, creed or national origin If 223YES,224 has it been five years since the termination of a sentence, parole or probation served for any offenses indicated above? Yes No If 223NO,224 attach an explanation. 6. Has any person listed in this Business Packet, or his or her spouse, had a cancellation of a TABC license / permit in the past five years? Yes No If 223YES,224 atta ch an explanation : American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Form L-B (/201) The applicant, license/permit holder, agent, servant or employee may not directly or indirectly have any overlapping ownerships or other prohibited relationship s (including unfair competition and unlawful trade practices) between those engaged in the alcoholic beverage industry at different levels, that is, between a manufacturer and a wholesaler or retailer, or between a wholesaler and a retailer, as the words "wholesaler," "retailer," and "manufacturer" are ordinarily used and understood, regardless of the specific names given a license\permit. Reference Chapter 102 et seq. 7 . Is any person , involved in this application, in violation of the above requirements? Yes No If 223YES,224 attach an explanat ion : WARNING AND SIGNATURE If Applicant Is/ Must Sign Individual/Individual Owner Corporation/Officer Partnership/Partner Limited Liability Company/ Officer or Manager Limited Partnership/General Partner EACH LICENSEE OR PERMITTEE SHALL HAVE EXCLUSIVE OCCUPANCY AND CONTROL OF THE ENTIRE LICENSED LOCATION WITH RESPECT TO SALE OF ALCOHOLIC BEVERAGES. ANY ARRANGEMENT THAT SURRENDERS SUCH CONTROL OF THE EMPLOYEES, PREMISES OR BUSINESS, INCLUDING PROFITS AND LOSSES, TO PERSONS OTHER THAN THE LICENSEE OR PERMITTEE IS UNLAWFUL. WARNING : Section 101.69 of the Texas Alcoholic Beverage Code states: 223205a person who makes a false statement or false representation in an application for a permit or license or in a statement, report, or other instrument to be filed with the Commission and required to be sworn commits an offense punishable by imprisonment in the Texas Department of Criminal Justice for not less than 2 nor more than 10 years.224 BY SIGNING YOU ARE SWEARING TO ALL INFORMATION AND ATTACHMENTS TO THIS PACKET. PRINT NAME SIGN HERE TITLE Before me, the undersigned authority, on this day of , 20 , the person whose name is signed to the foregoing application personally appeared and, duly sworn by me, states under oath that he or she has read the said application and that all the facts therein set forth are true and correct. SIGN HERE NOTARY PUBLIC S E A L American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 2 Form L-C (/201) CORPORATION L-C (/201) This Corporation form should be completed for original applications or for changes of officers, directors, stockholders, trustees, and beneficiaries holding ownership in this business. This form is included in the Business Packet (L-B) for new applicants. License/Permit holders reporting changes use Business Packet for Reporting Changes (L-BRC). For more information contact your local TABC office or visit us at: www.tabc .texas.gov ENTITY INFORMATION 1. Fed eral Employer Identification Number (FEIN) 2. Business Entity Name 3. Filing N umber 4 . Date Filed (mm/dd/yyyy) State Class and Number of Shares Issued CORPORATE OWNERSHIP INFORMATION Officer Director Stockholder Trustee Beneficiary SSN Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Class & No. of Share s Last Name First Name MI Title Officer Director Stockholder Truste e Beneficiary SSN Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Class & No. of Shares Last Name First Name MI Title Officer Director Stockholder Truste e Beneficiary SSN Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Class & No. of Shares Last Name First Name MI Title Officer Director Stockholder Trustee Beneficiary SSN Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Class & No. of Shares Last Name First Name MI Title American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Form L-C (/201) CORPORATE OWNERSHIP INFORMATION CONTINUED Officer Director S tockholder Trustee Beneficiary SSN Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Class & No. of Shares Last Name First Name MI Title Officer Director St ockholder Trustee Beneficiary SSN Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Class & No. of Shares Last Name First Name MI Title Officer Director Sto ckholder Trustee Beneficiary SSN Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Class & No. of Shares Last Name First Name MI Title Officer Director Stoc kholder Trustee Beneficiary SSN Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Class & No. of Shares Last Name First Name MI Title Officer Director Stock holder Trustee Beneficiary SSN Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Class & No. of Shares Last Name First Name MI Title Officer Director Stockh older Trus t e e Beneficiary SSN Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Class & No. of Shares Last Name First Name MI Title Officer Director Stockho lder Trustee Beneficiary SSN Out of Country Issuing State/DL No. Date of Birth (mm/dd/yyyy) Class & No. of Shares Last Name First Name MI Title IF YOU NEED MORE SPA CE USE ADDITIONAL C OPIES OF THIS PAGE American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 2 Form L-LLC (/201) LIMITED LIABILITY COMPANY L-LLC (/201) This Limited Liability Company form should be completed for original applications or for changes of officers, managers, and members holding ownership in this business. This form is included in the Business Packet (L-B) for new applicants. License/Permit holders reporting changes use the Business Packet for Reporting Changes (L-BRC). For individuals outside the United States, not holding a social security number check the "Out of Country" box. For more inform ation contact your local TABC office or visit us at: www.tabc .texas.gov ENTITY INFORMATION 1. Fe deral Employer Identification Number (FEIN) 2. Business Entity Name 3. Filing Number 4.Member Managed or Manage r Managed Member Managed Manager Managed 5 . Date Filed (mm/dd/yyyy) State Class and Number of Memberships or Units Issued LIMITED LIABILITY COMPANY OWNERSHIP INFORMATION Officer Manager Member SSN Out of Country I ssuing State/DL No. Date of Birth (mm/dd/yyyy) Membership or Units Held Last Name First Name MI Title Officer Manager Member SSN Out of Co