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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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