Intermunicipal Liquor License Transfer Application ApplicantApplicant Name First Last Applicant Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Applicant Telephone NumberApplicant Email Address Applicant's Interest Property OwnerProperty Owner Name First Last Property Owner Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Property Owner Telephone NumberProperty Owner Email Address Applicant's Interest Engineer/Architect/Surveyor (E/A/S)E/A/S Name First Last E/A/S Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code E/A/S Telephone NumberE/A/S Email Address Applicants Interest LocationSubdivision Name Location/Site Address/Tax Parcel Number Total Acerage Number of Acres to be Developed Proposed Use Dwelling Type Single Family Two Family Townhouses Multi-Family Commercial Industrial Other (Specify) Specify Location Zoning District Water Supply Public Other Specify (Water Supply) Sewage Disposal Public Other Specify (Sewage Disposal) PhasingTotal Number of Phases Phase Number This Application Total acres Acres this phase Total lots Total lots this phase Right-of-WayExisting/proposed agreements with adjacet properties? Yes No Describe (Right-of-Way) EasmentsExisting/proposed agreements with adjacet properties (Easements)? Yes No Describe (Easements) Comments/Other Information Applicant, being duly sworn, says he/she is: The owner of the property in question The authorized agent for the owner of record of the property for which the application is made. The owner's signed and notarized authorization to his/her agent to act on owner's behalf is required to be submitted Has an equitable interest in the property as submitted and documentation is attached to this application Signature of Applicant Name of Partnership Applicant First Last By Name of Corporate Applicant First Last By Title
