Assignment {2-37.4}

Page 1 of 2 Form 2-37.4 (0/201) ASSIGNMENT (Security for Taxes and/or Fees)2-37.4(0/201) Title 5, chapter 204, Section 204.01(d), and Section 204.02(b), Alcoholic Beverage Code 1977, As Amended (1) hereinafter called assignor, whose principal place of business is (2) (3) , , Texas, do (does) hereby assign, and set over the Texas Alcoholic Beverage Commission of the State of Texas, all right, title and interest of whatever nature, of assignor, in and to the insured account of assignor in the (4) evidenced by (5) in the amount of (6) $ numbered (7) Assignor agrees that this assignment carries with it the right to the insurance of the account by the (8) and includes and gives the right to the Administrator of the Texas Alcoholic Beverage Commission of the State of Texas to redeem, collect, and withdraw any part or the full amount of such account at any time WITHOUT NOTICE TO THE ASSIGNOR. This assignment is given as security for liability of taxes and/or permit fees, including interest and penalties, which may accrue under the provisions of the Alcoholic Beverage Code of the State of Texas and the Rules of Procedure of the Texas Alcoholic Beverage Commission. Assignor herby notifies the above named (4) of the assignment. SIGN Date HERE (Signature of Assignor) RECEIPT FOR NOTICE OF ASSIGNMENT Receipt is acknowledged to the Administrator of the Texas Alcoholic Beverage Commission of the State of Texas of written notice of the assignment to said State of Texas of the account identified above. We have noted in our records the State222s interest in said account as shown by the above assignment. We certify that we have received no notice of any lien, encumbrance, hold, claim, or obligation of the above- identified account prior to assignment to the State of Texas. We agree to make payment by mail to the State of Texas upon demand by mail in accordance with the laws applicable to this (9) . Date SIGN HERE (Signature of Bank Officer) (Title of Bank Officer) Name of Bank Address City, State, Zip (1) Name of Applicant: IF: Corporation ------------------------------------ Corporate name must be shown Partnership ------------------------------------ All partners222 names must be shown Limited Partnership -------------------------- Name of limited partnership and general partner must be shown Private Club ----------------------------------- Name of the club must be shown - (If Corporation - Corporate name) Proprietorship --------------------------------- Name of individual must be shown Limited Liability Partnership --------------- Name of limited liability partnership and all partners222 names must be shown Limited Liability Company ----------------- Name of limited liability company must be shown (2)Trade Name of Business(6)Amount in words and figures(3)Actual Business Address and City (Not Mail Address)(7)Number of C.D. or Savings Account(4)Name of Bank, association or credit union(8)Name of U.S. Agency insuring deposit (5) Descri ption of automatically renewable time Certificate of Deposit or Savings Account (9) Bank, association or credit union THE ASSIGNMENT OF THIS CERTIFICATE OF DEPOSIT OR SAVINGS ACCOUNT PASSBOOK PROHIBITS THE BANK FROM DISPERSING THE PRINCIPAL MONIES ASSIGNED TO THE TEXAS ALCOHOLIC BEVERAGE COMMISSION UNTIL RELEASED OR DISCHARGED, IN WRITING, BY THE TEXAS ALCOHOLIC BEVERAGE COMMISSION. TAX SECURITY MUST BE SUBMITTED WITH EACH ORIGINAL AND EACH RENEWAL APPLICATION, IN ORDER THAT WE MAY HAVE SEPARATE TAX LIABILITY TO COVER EACH PERMIT YEAR. (COMPLETE THE NEXT PAGE) American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Form 2-37.4 (0/201) ACKNOWLEDGMENTS No. 1 (FOR ASSIGNOR) BEFORE ME, the undersigned authority in and for said State on this day personally appeared known to me to be the person whose name is subscribed to the (Name of Assignor)foregoing instrument, and acknowledged to me that he or she executed the same, for the purposes and considerations therein expressed. Given under my hand and seal of office, this day of A.D., SIGN HERE (S E A L) Notary Public No. 2 (FOR BANK OR SAVINGS ASSOCIATION) BEFORE ME, the undersigned authority in and for said State on this day personally appeared known to me to be the person whose name is (Name of Bank Officer) subscribed to the foregoing instrument, and acknowledged to me that he or she executed the same as the act and deed of the bank thereof, and for the purposes and considerations therein expressed, and in the capacity therein stated. Given under my hand and seal of office, this day of A.D., SIGN HERE (S E A L) Notary Public NO. 1 226 ASSIGNOR Name of assignor (permittee/licensee) who signed the assignment must be shown. Notary public must date, sign the acknowledgment and affix notary seal. NO. 2 226 BANK OR SAVINGS ASSOCIATION Name of bank officer who signed the assignment must be shown. Notary Public must date sign the acknowledgment and affix notary seal. INSTRUCTIONS 1.This assignment form may only be used for Security for Taxes and/or Permit Fees purposes and the certificate of deposit orsavings account must be issued by a Texas bank, savings institution or credit union. 2.Upon expiration of a license or permit, its voluntary cancellation, or upon the applicant222s subsequent approval for exemptionfrom the security requirements, the licensee or permittee may request (in writing) the r elease and return of the security supporting their license or permit. 3.The release of this security will not be unreasonably withheld; however, the bank, savings institution or credit union is notreleased form its obligation until they receive written notice of the release from this agency. American LegalNet, Inc. www.FormsWorkFlow.com