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Click ‘Get Form’ to open it in the editor.
Begin by entering your full name and premises address in the designated fields. Ensure that your telephone number is accurate.
Provide your Employer Identification Number (EIN) as required, noting that a Social Security number is not acceptable.
Fill in the operating name (DBA) and any labeling trade names if applicable. Check all business activities that will be conducted at your premises address.
Indicate the reason for your application, selecting from options such as 'New Business' or 'Change in Ownership.' Include relevant dates where necessary.
List all owners and key personnel in Item 8, providing their titles and percentage of voting stock or interest.
Complete Items 9 through 11 regarding personal information and any past permit issues. Use separate sheets if more space is needed.
Finally, affirm the application by signing and dating it, ensuring all information is true and complete before submission.
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