Form At-112 - Application For Transfer Of Licenses For Sale Of Fermented Malt Beverages And/or Intoxicating Liquor From One Premises To Another - Wisconsin Department Of Revenue

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RETAIL LICENSE TRANSFER – PREMISES TO PREMISES
FEE $
Wisconsin Department of Revenue
APPLICATION FOR TRANSFER OF LICENSES FOR SALE OF FERMENTED MALT BEVERAGES
AND/OR INTOXICATING LIQUOR FROM ONE PREMISES TO ANOTHER
, Wisconsin
, 20
To the governing body of the
City
Village
Town
of
County of
Wisconsin.
The undersigned hereby applies for a transfer of Class
license from
to
(present location)
(proposed location)
on or about
.
(date)
1.
APPLICANT:
(print name and address plainly)
(a)
Full name of applicant
(b)
Address
2.
LOCATION AND DESCRIPTION OF PREMISES TO WHICH APPLICATION FOR TRANSFER IS MADE:
Describe building or buildings where alcohol beverages are to be sold, served and stored.
(a)
Street number
(b)
Trade name of establishment
(c)
Physical description of building, buildings and/or land area comprising licensed premises.
(d)
Legal description (omit if street address is given above.)
(e)
Is any other business conducted on same premises?
Yes
No
If so, what?
(f)
Was this location licensed for beer or liquor during the past year?
Yes
No
(g)
Give name and address of previous licensee.
(h)
Will the previous licensee surrender its license?
Yes
No
AT-112 (R. 4-09)
Wisconsin Department of Revenue

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