Form ABC-211-A "License Transfer Request ("sign off")" - California

What Is Form ABC-211-A?

This is a legal form that was released by the California Department of Alcoholic Beverage Control - a government authority operating within California. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on July 1, 2019;
  • The latest edition provided by the California Department of Alcoholic Beverage Control;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form ABC-211-A by clicking the link below or browse more documents and templates provided by the California Department of Alcoholic Beverage Control.

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Download Form ABC-211-A "License Transfer Request ("sign off")" - California

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State of California
Department of Alcoholic Beverage Control
LICENSE TRANSFER REQUEST ("SIGN OFF")
1. DISTRICT OFFICE
2. LICENSE NUMBER
• This form is to be signed by transferors only.
• Read instructions before completing.
• All signatures must be witnessed by an ABC
3. TRANSACTION TYPE
employee or notarized in accordance with laws
Exchange
Premise to Premise Transfer
of the State where signed.
Person to Person Transfer
Other
4. LICENSEE'S NAME (Transferor/Seller)
5. APPLICANT'S NAME (Transferee/Buyer)
6. EXISTING PREMISES ADDRESS
7. LICENSEE'S MAILING ADDRESS (Transferor/Seller)
8. LICENSEE'S PHONE NUMBER
I hereby request surrender of my license under Section 24045.5(b) of the ABC Act so that a Temporary Permit may be issued to the
transferee.
9. SIGNATURE OF TRANSFEROR/SELLER FOR TEMPORARY PERMIT (Only one signature required)
DATE SIGNED
X
10. RENEWAL DUE DATE
11. SURRENDER DATE
12. TEMP. EFFECTIVE DATE
13. TEMP. EXPIRATION DATE
TRANSFEROR'S CERTIFICATION
Under penalty of perjury, each person whose signature appears below, certifies and says: (1) He is the licensee named in the foregoing
transfer application, duly authorized to make this transfer application; (2) that he hereby makes application to surrender all interest in the
license(s) described above and to transfer same to the applicant and/or location indicated on the upper portion of this form, if such transfer is
approved by the Director; (3) that the transfer application or proposed transfer is not made to satisfy the payment of a loan or to fulfill an
agreement entered into more than ninety days preceding the day on which the transfer application is filed with the Department or to gain or
establish a preference to or for any creditor of transferor or to defraud or injure any creditor of transferor; (4) that the transfer application may
be withdrawn by either the applicant or the licensee with no resulting liability to the Department.
SOLE OWNER
14. PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PARTNERSHIP/LIMITED PARTNERSHIP (Signatures of general partners only)
15. PARTNER'S PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PARTNER'S PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PARTNER'S PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
CORPORATION
16. PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
TITLE
President
Vice President
Chairman of the Board
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
TITLE
Secretary
Asst. Secretary
Chief Financial Officer
Asst. Treasurer
LIMITED LIABILITY COMPANY
17. The limited liability company is member-run
Yes
No
(If no, complete Item #18 below)
18. NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Last, first, middle)
ABC INITIALS/DATE (ABC use only)
19. LLC MEMBER'S PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
LLC MEMBER'S PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
ABC-211-A (07/19)
"SIGN OFF"
State of California
Department of Alcoholic Beverage Control
LICENSE TRANSFER REQUEST ("SIGN OFF")
1. DISTRICT OFFICE
2. LICENSE NUMBER
• This form is to be signed by transferors only.
• Read instructions before completing.
• All signatures must be witnessed by an ABC
3. TRANSACTION TYPE
employee or notarized in accordance with laws
Exchange
Premise to Premise Transfer
of the State where signed.
Person to Person Transfer
Other
4. LICENSEE'S NAME (Transferor/Seller)
5. APPLICANT'S NAME (Transferee/Buyer)
6. EXISTING PREMISES ADDRESS
7. LICENSEE'S MAILING ADDRESS (Transferor/Seller)
8. LICENSEE'S PHONE NUMBER
I hereby request surrender of my license under Section 24045.5(b) of the ABC Act so that a Temporary Permit may be issued to the
transferee.
9. SIGNATURE OF TRANSFEROR/SELLER FOR TEMPORARY PERMIT (Only one signature required)
DATE SIGNED
X
10. RENEWAL DUE DATE
11. SURRENDER DATE
12. TEMP. EFFECTIVE DATE
13. TEMP. EXPIRATION DATE
TRANSFEROR'S CERTIFICATION
Under penalty of perjury, each person whose signature appears below, certifies and says: (1) He is the licensee named in the foregoing
transfer application, duly authorized to make this transfer application; (2) that he hereby makes application to surrender all interest in the
license(s) described above and to transfer same to the applicant and/or location indicated on the upper portion of this form, if such transfer is
approved by the Director; (3) that the transfer application or proposed transfer is not made to satisfy the payment of a loan or to fulfill an
agreement entered into more than ninety days preceding the day on which the transfer application is filed with the Department or to gain or
establish a preference to or for any creditor of transferor or to defraud or injure any creditor of transferor; (4) that the transfer application may
be withdrawn by either the applicant or the licensee with no resulting liability to the Department.
SOLE OWNER
14. PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PARTNERSHIP/LIMITED PARTNERSHIP (Signatures of general partners only)
15. PARTNER'S PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PARTNER'S PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PARTNER'S PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
CORPORATION
16. PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
TITLE
President
Vice President
Chairman of the Board
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
TITLE
Secretary
Asst. Secretary
Chief Financial Officer
Asst. Treasurer
LIMITED LIABILITY COMPANY
17. The limited liability company is member-run
Yes
No
(If no, complete Item #18 below)
18. NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Last, first, middle)
ABC INITIALS/DATE (ABC use only)
19. LLC MEMBER'S PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
LLC MEMBER'S PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
ABC-211-A (07/19)
"SIGN OFF"
State of California
Department of Alcoholic Beverage Control
LICENSE TRANSFER REQUEST
LICENSE NUMBER
TRANSFEROR'S CERTIFICATION
Under penalty of perjury, each person whose signature appears below, certifies and says: (1) He is the licensee named in the foregoing
transfer application, duly authorized to make this transfer application; (2) that he hereby makes application to surrender all interest in the
license(s) described above and to transfer same to the applicant and/or location indicated on the upper portion of this form, if such transfer is
approved by the Director; (3) that the transfer application or proposed transfer is not made to satisfy the payment of a loan or to fulfill an
agreement entered into more than ninety days preceding the day on which the transfer application is filed with the Department or to gain or
establish a preference to or for any creditor of transferor or to defraud or injure any creditor of transferor; (4) that the transfer application may
be withdrawn by either the applicant or the licensee with no resulting liability to the Department.
ADDITIONAL SIGNATURES
20. PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
PRINTED NAME (Last, first, middle)
SIGNATURE
DATE SIGNED
X
ABC-211-A (07/19) (reverse)
"SIGN OFF"
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