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CONFIDENTIAL - Business Licensing Service

CONFIDENTIAL - Business Licensing Service 2026

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The document is a Personal/Criminal History Statement required by the State of Washington's Business Licensing Service for individuals applying for endorsements related to liquor, gambling, lottery, and cigarette/tobacco sales. It collects personal information, criminal history, employment history, and residence details to assess eligibility for licensing. The form emphasizes the importance of truthful disclosures and outlines the consequences of providing false information.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your License Number and UBI Number at the top of the form. This information is crucial for identification.
In the Personal/Criminal History Statement section, clearly indicate the type of endorsements you are applying for by checking the appropriate boxes.
Fill in your Business Name and Business Location Address accurately. Ensure all fields are completed; if a field does not apply, write 'N/A'.
Indicate your status (e.g., Sole Proprietor, Corporate Officer) by checking all applicable boxes and provide your title.
Complete personal details such as your name, Social Security Number, home address, and contact numbers. Be thorough to avoid delays.
Answer all questions in the Criminal History Statement honestly. If applicable, provide detailed explanations for any 'YES' responses.
Review your entries for accuracy before signing and dating the certification section at the end of the form.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (32 Votes)
2012	4.9 Satisfied (42 Votes)

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