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 Number Country Phone Number Applicant Email Address Applicant's InterestProperty 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 Number Country Phone Number Property Owner Email Address Applicant's InterestEngineer/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 Number Country Phone Number E/A/S Email Address Applicants InterestLocationSubdivision NameLocation/Site Address/Tax Parcel NumberTotal AcerageNumber of Acres to be DevelopedProposed UseDwelling Type Single Family Two Family Townhouses Multi-Family Commercial Industrial Other (Specify) SpecifyLocation Zoning DistrictWater Supply Public Other Specify (Water Supply)Sewage Disposal Public Other Specify (Sewage Disposal)PhasingTotal Number of PhasesPhase Number This ApplicationTotal acresAcres this phaseTotal lotsTotal lots this phaseRight-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 InformationApplicant, 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 ApplicantName of Partnership Applicant First Last ByName of Corporate Applicant First Last ByTitle
