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FINANCIAL DIS CLOSURE STATEMENT
<br />On-Sale Liquor License (InmxicaKng)
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<br />S~ate ~H names, residences, business addresses and telephone numbers of the o~,mer or or/nets of
<br />~he build~,g whereto the Licer~ed business will be located, ff ~e owner is other hha_n ~e applicant
<br /> other than new corts~'uc:~on).
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<br />Where the building is ow'ned by other e_ha= appLiczme, state in summary ~e conditior~ of ~he lease
<br />arrangement, such as, term of lease, mon~,hly rent, I, renewal privileges, etc.
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<br />Iii. L~ tine building m ow-ned by the individual applicant, parmership, corporation, or association, state:
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<br />A) Date purchased (or pla.petal com?tetSon date for new consmaction).
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<br />13) Lf new consmac~on, total cost of the building and method of ~-'m.ncmg such cost.
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<br />I) Lf fina.nced by mortgage, name ired address of mortgage holder.
<br />2) ff conmact for deed, name and address o£ holder of such cont=act for d~d.
<br />$) Rate of ~terest on mortgage or con=act for deed.
<br />4) Monthly payment for iiquida~on o£ mortgage andZor cone-act for deed.
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<br />State the total cost of asse~ acquffed to start this business including the business premises, if
<br />purchased, f,.:<~u~,'es, furn/tnre, equipment, merchandise for resale, cash for working capital, prepaid
<br />irusura.-nce, and any other assets.
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<br />A)
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<br />O£ the above cos~ o£ ~se~ acquired, sate the amount g'~at is provided by ~e person(s)
<br />inv~tiqg in ~,iz business (attach proof of the source of suc~N money).
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<br />Give l~il names, addresses, telephone numbers of all persor~, other ~h~ the a?pHca, m, who have
<br />~y fmanciaI Nterest m ~e bus~s, bufldmgs, premNes, ~mres, ~mre, or stock ~ :~de. State
<br />· e nature of ~e interest amount ~ereof, ~d ~e te~ for payment or o~er re~bursement (~
<br />sh~ mcludm, but not be ~ed ~o, any Ieasees, lessors, mortgagors, mortgagees, lendees, ~
<br />holders, ~tees, ~stors ~d perso~ who have cosi~ed noms or o~e~e lo~ed, pledged or
<br />extended secum~ for ~y ~debtedn~s of the appHc~t).
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<br />Full Name:
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<br />Phone Number:
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<br />Address:
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<br />Nature '
<br /> o~ mteres
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<br />Full Name:
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<br />Addr~s:
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<br />Nature of interest:
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<br />Phone Number:
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