Form Va-1 - Application For Voluntary Association Page 2
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4APPLICATION FOR VOLUNTARY ASSOCIATION
Page 2
The Names and Addresses of the Officers, Owners or Members of the Voluntary Association who have
8.
authority to sign documents are [at least two (2) individuals must be listed; attach additional sheet if
necessary]:
Name
Street Address/City/State/Zip Code
__________________________________ ___________________________________________________
__________________________________ ___________________________________________________
9. Attach any additional statement which may be required for the type of business to be conducted.
Check here if you have attached a separate additional statement.
Check here acknowledging that the members of the association consent to recognition of the application by the
laws of the State of West Virginia with respect to corporation to the voluntary association.
Check here if the association will apply for a license to sell alcoholic beverages. The members agree to the
following:
The purpose of this restaurant and business establishment will be that of selling, servicing and disbursing
alcoholic beverages, providing that a West Virginia Alcoholic Beverage Control Commission License is
issued, and for the disbursing of food and foodstuffs from its kitchen facilities located on said premise and any
and all other business activities pertinent to and being a common part of the general business of restaurants,
bars, supper clubs and related businesses of this type.
The aforesaid officers, hereinabove stated, mutually covenant and agree that they join themselves together for
a common business purpose and, as such association members and officers, they fully intend to perform all
the duties and functions of their particular offices, and that by their subsequent signatures to their Agreement
of Association, they do pledge themselves to join in a common effort for the promotion and financial success
of this said restaurant business.
Said officers further mutually covenant and agree that they shall not knowingly violate any law of the State of
West Virginia and or the United States of America and that they shall operate said restaurant business
establishment at all times in a lawful manner and in a clean and decent atmosphere. Said officers further
mutually covenant and agree that they shall make a proper accounting of said business and meet their
obligations in as responsible a business manner as is available to them, and that no officer nor member of this
association shall, in any way, cause his or her interest to be sold or disposed of unless first offering his or her
interest to be sold to other members of this association as their right of first refusal to purchase the same.
This Agreement of Association is made and entered into by all members hereto as a joint venture and shall be
treated as such until otherwise indicated. The members of this association by their signatures to this
agreement, mutually covenant and state that they have read the foregoing agreement and consent to all the
terms and conditions herein contained.
10. Signature and Contact Information* (See below Important Legal Notice Regarding Signature):
Contact Name and Phone Number of person to reach in case of a problem with filing.
_________________________________________________
_________________________________
Contact Name
Phone Number
______________________________ _____________________________________ _________________
Print Name of Signer
Signature
Date
*Important Legal Notice Regarding Signature: Per West Virginia Code §31D-1-129. Penalty for signing false document.
Any person who signs a document he or she knows is false in any material respect and knows that the document is to be delivered to
the secretary of state for filing is guilty of a misdemeanor and, upon conviction thereof, shall be fined not more than one thousand
dollars or confined in the county or regional jail not more than one year, or both.
Form VA-1
Issued by the Office of the Secretary of State
Revised 4/13
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