Form ABC-812 "P-12(A) Request/Acknowledgement Form" - California

What Is Form ABC-812?

This is a legal form that was released by the California Department of Alcoholic Beverage Control - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2011;
  • 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-812 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-812 "P-12(A) Request/Acknowledgement Form" - California

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P-12(A) Request/Acknowledgement Form
The following is to be completed by an entity that currently holds 10% or greater interest in more
than one applicant entity or more than one entity already licensed by the Department (or both),
and has been granted, or is requesting P-12(A) status:
REQUESTING ENTITY:
ASSOCIATED
APPLICANT/LICENSEE
ENTITY(S):
CHECK ONE:
Our designated base/master file is held in the Department’s _________________ District
Office under file number ____________.
We are requesting P-12(A) status under file number ____________ held in the
Department’s ___________________ District Office.
We hereby request waiver of submission of documents which would otherwise be required to
establish our qualification as an entity holding 10% or greater interest in an alcoholic beverage
license.
We hereby attest, under penalty of perjury, that all information (including forms
ABC-208 [Personal Affidavit], ABC-243 [Corporate Questionnaire], ABC-256 [Limited
Partnership Questionnaire], ABC-256-LLC [Limited Liability Questionnaire] and all related
supporting documents in the above-identified licensing file are accurate and current.
We understand that actual licensees associated with this entity may be required to report changes
to this entity, pursuant to Business and Professions Code Sections 24071, 24071.1, and/or
24071.2, and California Code of Regulations Rule 68.5.
We recognize that a determination by the Department that this statement is materially false could
lead to denial of an application and/or disciplinary action against any licensee associated with
this entity.
___________________________________
________________
Signature of entity representative
Date
ABC-812 (11/11)
P-12(A) Request/Acknowledgement Form
The following is to be completed by an entity that currently holds 10% or greater interest in more
than one applicant entity or more than one entity already licensed by the Department (or both),
and has been granted, or is requesting P-12(A) status:
REQUESTING ENTITY:
ASSOCIATED
APPLICANT/LICENSEE
ENTITY(S):
CHECK ONE:
Our designated base/master file is held in the Department’s _________________ District
Office under file number ____________.
We are requesting P-12(A) status under file number ____________ held in the
Department’s ___________________ District Office.
We hereby request waiver of submission of documents which would otherwise be required to
establish our qualification as an entity holding 10% or greater interest in an alcoholic beverage
license.
We hereby attest, under penalty of perjury, that all information (including forms
ABC-208 [Personal Affidavit], ABC-243 [Corporate Questionnaire], ABC-256 [Limited
Partnership Questionnaire], ABC-256-LLC [Limited Liability Questionnaire] and all related
supporting documents in the above-identified licensing file are accurate and current.
We understand that actual licensees associated with this entity may be required to report changes
to this entity, pursuant to Business and Professions Code Sections 24071, 24071.1, and/or
24071.2, and California Code of Regulations Rule 68.5.
We recognize that a determination by the Department that this statement is materially false could
lead to denial of an application and/or disciplinary action against any licensee associated with
this entity.
___________________________________
________________
Signature of entity representative
Date
ABC-812 (11/11)