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FINANCIA. L 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 wilt be located, if the owner is other than the <br />applicant (if other than new construction). <br /> <br />Where the building is owned by other than applicant, state in summary the conditions of the <br />lease arrangement, such as, term of lease, monthly rental, renewal privileges, etc. <br /> <br />If the building is owned by the individual applicant, partnership, corporation, or association, <br />state: <br /> <br />A) Date purcha~'d (or planned completion date for new construction). <br /> <br />B ) If new construction, total cost of the building and method of financing such cost. <br /> <br />1) 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 /> <br />State the total cost of assets acquired to start this business including the business premises, if <br />purchased, fixtures, furniture, equipment, merchandise for resale, cash for working capital, <br />prepaid insurance, and any other assets. <br /> <br />,4.) 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). <br /> <br />Give full names, addresses, telephone numbers of alt persons, other than the applicant, who have <br />any financial interest in the business, buildings, premises, fixtures, furniture, or stock in trade. <br />State the nature of the interest amount thereof, and the terms for payment or other reimbursement <br />(this shall include, but not be limited to, any leasees, les'kors, mortgagors, mortgagees, lendees, <br />lien holders, trustees, trustors and persons who have cosigned notes or otherwise loaned, pledged <br />or extended security for any indebtedness of the applicant). <br /> <br />P~one Number: ~-.~ - ~.~-_~ g ?~. <br /> <br /> <br />