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Click ‘Get Form’ to open it in the editor.
Begin with SECTION 1. Fill in your LICENSEE'S NAME, LICENSE NUMBER, and DOING BUSINESS AS (DBA). Ensure accuracy as this information is crucial for identification.
Provide the DISTRICT OFFICE and PREMISES ADDRESS. If applicable, indicate whether the LICENSE is attached by selecting 'Yes' or 'No'.
Complete the MAILING ADDRESS field to ensure correspondence reaches you.
Move to SECTION 2 for CANCELLATION. If you are canceling your license, check the appropriate box and specify the CANCELLATION EFFECTIVE date.
Sign where indicated and provide your HOME PHONE NUMBER. Repeat similar steps for SURRENDER in SECTION 3, ensuring all details are filled accurately.
In SECTION 4, if surrendering privileges for a special event, detail the specific room or area and the dates of surrender.
Finally, review all sections for completeness before submitting your form through our platform.

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