Laserfiche WebLink
FINANCIAL DISCLOSURE STATEMENT <br />Off-Sale Liquor License (Intoxicating) <br /> <br />State full names, residences, business addresses and telephone numbers of the owner or owners of <br />the building wherein the licensed business will be located, if the owner is other than the applicant <br />(ff other than new construction). <br /> <br />II. <br /> <br />Where the building is owned by other than applicant, state in summary the conditions of the lease <br />arrangement, such as, term of lease, monthly rental, renewal privi/eges, etc. <br /> <br />Eli. If the building is owned by the individual applicant, partnership, corporation, or associatdon, state: <br /> <br />A) Date purchased (or planned completion date for n~w construction). <br /> <br />B) If new construction, total cost of the building and method of financing such cost. <br /> <br /> I) If financed by mortgage, name and address 'of mortgage holder. <br /> 2) If contract for deed, name and address of holder of such contract for deed. <br /> 3) Rate of interest on mortgage or contract for deed. <br /> 4) Monthly payment for liquidation of mortgage and/or contract for deed. <br /> the total cost of~se~h~, cquired to stm't this business including the business premises, ff <br />State <br />purchased, fixtures, furFd~e~e, equiprn.ent, merchandise for resale, cash for working capital, prepaid <br />insurance, and any other assets. <br /> <br />Of the above costs of assets acquired, state the amount that is provided by the person(s) <br />investing in this business (attach proof of the source of such money). 300. ooo <br /> <br /> Give full names, addresses, telephone numbers of ail persons, other than the applicant, who have <br /> any financial interest in the business, buildings, premises, fix~res, furniture, or stock in trade. State <br /> <br />· the nature of the interest amount thereof, and the terms for payment or other reimb~.tr~ement (this <br /> shall include, but not be limited to, any leasees, lessors, mortgagors, mortgagees, lendees, lien <br /> holders, trustees, trustors and persons who have cosigned notes or otherwise loaned, pledged or <br /> extended security for any indebtedness of the applicant). <br /> <br />Phone Number: <br /> <br />Na ure of I_uteresP. <br /> <br />Full Name: <br /> <br />Address: <br /> <br />I <br />I <br />I <br /> <br /> <br />