HomeMy WebLinkAboutApp for Alcoholic beverage license - Forbestown store & deli Department of Alcoholic Beverage Control State of California
APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE(S)
ABC 211 (6199)
TO:Department of Alcoholic Beverage Control File Number: 503672
1900 CHURN CREEK RD Receipt Number: 2018595
STE 215 Geographical Code: 0400
REDDING, CA 96002 Copies Mailed Date: September 21,2010
(530)224-4830 Issued Date:
DISTRICT SERVING LOCATION: REDDING
First Owner: ANDERS,NANCY THERESA softop .
Name of Business: FORBESTOWN STORE& DELI
Location of Business: 191.75 NEW YORK FLAT RD SEP.. ,x_2010
FORBESTOWN, CA 95941 QROWLLE
County: BUTTE ,CALIFORNIA
Is Premise inside city limits? No Census Tract 0024.00
Mailing Address: PO BOX 115
(If different from FORBESTOWN, CA 959410115
premises address)
Type of license(s): 20
Transferor's license/name: 457765 1 MURPHY,DUANE EMMITT Dropping Partner: Yes No2�
License ape, Transaction Type Fee Type Master Dup Date Fee
NA STATE FINGERPRINTS NA N 2 09/21/10 $78.00
NA FEDERAL FINGERPRINTS NA N 2 09/21/10 $48.00
NA ISSUE TEMPORARY PERMIT NA Y 0 09/21/10 $100.00
20-Off-Sale Beer And Wine PERSON-TO-PERSON TRANSFER NA Y 0 09/21/10 $50.00
20-Of-Sale Beer And Wine ANNUAL FEE NA Y 0 09/21/10 $254.00
Total $530.00
Have you ever been convicted of a felony? No
Have you ever violated any provisions of the Alcoholic Beverage Control Act,or regulations of the
Department pertaining to the Act? No
Explain any"Yes"answer to the above questions on an attachment which shall be deemed part of this application.
Applicant agrees(a)that any manager employed in an on-sale licensed premises will have all the qualifications of
a licensee,and(b)that he will not violate or cause or permit to be violated any of the provisions of the Alcoholic
Beverage Control Act.
STATE OF CALIFORNIA County of BUTTE Date: September 21,2010
Under penalty of perjury,each person whose signature appears below,certifies and says:(1) He is an applicant,or one of the applicants,or an executive officer
of the applicant corporation,named in the foregoing application,duly authorized to make this application on its behalf;(2) that he has read the foregoing and
knows the contents thereof and that each of the above statements therein made are true;(3) that no person other than the applicant or applicants has any direct
or indirect interest in the applicant or applicant's business to be conducted under the license(s)for which this application is made;(4) that the transfer
application or proposed transfer is not made to satisfy the payment of a loan or to fulfill an agreement entered into more than ninety(90)days preceding the day
on which the transfer application is filed with the Department or to gain or establish a preference to or for any creditor or transferor or to defraud or injure any
creditor oftransferor;(5) that the transfer application may be withdrawn by either the applicant or the licensee with no resulting liability to the Department.
Applicant Name(s) Applicant Signature(s)
.ANDERS,NANCY THERESA
V-,/-
cc