Form ABC-217 "Application Questionnaire" - California

This version of the form is not currently in use and is provided for reference only.
Download this version of Form ABC-217 for the current year.

What Is Form ABC-217?

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 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-217 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-217 "Application Questionnaire" - California

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Department of Alcoholic Beverage Control
State of California
Gavin Newsom, Governor
APPLICATION QUESTIONNAIRE
Please read instructions, which includes Privacy Notice, before completing form.
1. APPLICANT'S NAME(S) (If an individual, first name, middle name, last name. Name of entity if corporation, limited partnership or limited liability company.)
P-12 LICENSEE
Yes
No
(If yes, complete form ABC-811)
2. LICENSE TYPE(S) (Check appropriate items)
3. TRANSACTION TYPE (Check appropriate item)
20 Off-Sale Beer & Wine
Original (New)
21 Off-Sale General
Person-to-Person Transfer (check appropriate section):
40 On-Sale Beer
Section 24071 (Surviving spouse, corporations, fiduciaries, etc.)
41 On-Sale Beer & Wine Eating Place
Section 24071.1 (Corporate Stock/Limited Partnership)
42 On-Sale Beer & Wine Public Premises
Section 24071.2 (Limited Liability Company)
47 On-Sale General Eating Place
Premises-to-Premises Transfer
48 On-Sale General Public Premises
Exchange
Other
Other
4. TEMPORARY PERMIT REQUESTED (Person-to-Person transfers only)
Yes
No
5. PREMISES ADDRESS (Where license to be issued) (Street number and name, city, zip code)
County
6. PREMISES TELEPHONE NUMBER
7. PREMISES ARE INSIDE CITY LIMITS
8. BUSINESS NAME (DBA) YOU WILL USE
Yes
No
9. BUSINESS MAILING ADDRESS (Street number and name, city, state, zip code)
10. MAILING ADDRESS
Permanent
Temporary
11. ABC LICENSE COST (Item #33a on reverse)
12. SUBTOTAL (Item #33f on reverse)
13. HAS THE APPLICANT(S) EVER BEEN
14. HAS THE APPLICANT(S) EVER VIOLATED ANY OF THE PROVISIONS OF THE ALCOHOLIC BEVERAGE CONTROL ACT OR REGULATIONS
CONVICTED OF A FELONY?
OF THE DEPARTMENT PERTAINING TO THE ACT?
Yes
No
Yes
No
15. IF YES TO ITEM 13 OR 14, PLEASE EXPLAIN
16. TRANSFEROR'S NAME (If an individual, last, first, middle. Name of entity if corporation, limited partnership or limited liability company.)
17. ABC LICENSE NUMBER
18. TRANSFEROR'S PREMISES ADDRESS (Where license is now issued) (Street number and name, city, zip code)
19. PREMISES UNDER CONSTRUCTION
IF YES, LIST ESTIMATED COMPLETION DATE
20. FRANCHISE
Yes
No
Yes
No
21. NAME OF PERSON WE MAY CONTACT (For the applicant)
22. TITLE OF CONTACT PERSON
23. CONTACT TELEPHONE NUMBER
24. CONTACT E-MAIL ADDRESS
25. PREMISES IS CURRENTLY LICENSED
IF YES, TYPE OF LICENSE
26. CURRENT LICENSE IS OPERATING
IF NO, DATE CLOSED
Yes
No
Yes
No
FINANCIAL INFORMATION
27. ESCROW COMPANY'S NAME
ESCROW COMPANY'S ADDRESS
TELEPHONE NUMBER
28. BOOKKEEPER/ACCOUNTANT'S NAME
BOOKKEEPER/ACCOUNTANT'S ADDRESS
TELEPHONE NUMBER
29. LANDLORD'S NAME
LANDLORD'S ADDRESS
TELEPHONE NUMBER
30. MONTHLY RENT
31. LEASE EXPIRATION DATE
32. INDICATE WHETHER LEASE OR RENTAL AGREEMENT INCLUDES FURNITURE OR FIXTURES
All
Some
None
ABC-217 (rev. 11/11)
Department of Alcoholic Beverage Control
State of California
Gavin Newsom, Governor
APPLICATION QUESTIONNAIRE
Please read instructions, which includes Privacy Notice, before completing form.
1. APPLICANT'S NAME(S) (If an individual, first name, middle name, last name. Name of entity if corporation, limited partnership or limited liability company.)
P-12 LICENSEE
Yes
No
(If yes, complete form ABC-811)
2. LICENSE TYPE(S) (Check appropriate items)
3. TRANSACTION TYPE (Check appropriate item)
20 Off-Sale Beer & Wine
Original (New)
21 Off-Sale General
Person-to-Person Transfer (check appropriate section):
40 On-Sale Beer
Section 24071 (Surviving spouse, corporations, fiduciaries, etc.)
41 On-Sale Beer & Wine Eating Place
Section 24071.1 (Corporate Stock/Limited Partnership)
42 On-Sale Beer & Wine Public Premises
Section 24071.2 (Limited Liability Company)
47 On-Sale General Eating Place
Premises-to-Premises Transfer
48 On-Sale General Public Premises
Exchange
Other
Other
4. TEMPORARY PERMIT REQUESTED (Person-to-Person transfers only)
Yes
No
5. PREMISES ADDRESS (Where license to be issued) (Street number and name, city, zip code)
County
6. PREMISES TELEPHONE NUMBER
7. PREMISES ARE INSIDE CITY LIMITS
8. BUSINESS NAME (DBA) YOU WILL USE
Yes
No
9. BUSINESS MAILING ADDRESS (Street number and name, city, state, zip code)
10. MAILING ADDRESS
Permanent
Temporary
11. ABC LICENSE COST (Item #33a on reverse)
12. SUBTOTAL (Item #33f on reverse)
13. HAS THE APPLICANT(S) EVER BEEN
14. HAS THE APPLICANT(S) EVER VIOLATED ANY OF THE PROVISIONS OF THE ALCOHOLIC BEVERAGE CONTROL ACT OR REGULATIONS
CONVICTED OF A FELONY?
OF THE DEPARTMENT PERTAINING TO THE ACT?
Yes
No
Yes
No
15. IF YES TO ITEM 13 OR 14, PLEASE EXPLAIN
16. TRANSFEROR'S NAME (If an individual, last, first, middle. Name of entity if corporation, limited partnership or limited liability company.)
17. ABC LICENSE NUMBER
18. TRANSFEROR'S PREMISES ADDRESS (Where license is now issued) (Street number and name, city, zip code)
19. PREMISES UNDER CONSTRUCTION
IF YES, LIST ESTIMATED COMPLETION DATE
20. FRANCHISE
Yes
No
Yes
No
21. NAME OF PERSON WE MAY CONTACT (For the applicant)
22. TITLE OF CONTACT PERSON
23. CONTACT TELEPHONE NUMBER
24. CONTACT E-MAIL ADDRESS
25. PREMISES IS CURRENTLY LICENSED
IF YES, TYPE OF LICENSE
26. CURRENT LICENSE IS OPERATING
IF NO, DATE CLOSED
Yes
No
Yes
No
FINANCIAL INFORMATION
27. ESCROW COMPANY'S NAME
ESCROW COMPANY'S ADDRESS
TELEPHONE NUMBER
28. BOOKKEEPER/ACCOUNTANT'S NAME
BOOKKEEPER/ACCOUNTANT'S ADDRESS
TELEPHONE NUMBER
29. LANDLORD'S NAME
LANDLORD'S ADDRESS
TELEPHONE NUMBER
30. MONTHLY RENT
31. LEASE EXPIRATION DATE
32. INDICATE WHETHER LEASE OR RENTAL AGREEMENT INCLUDES FURNITURE OR FIXTURES
All
Some
None
ABC-217 (rev. 11/11)
COST
33. INVESTMENT INFORMATION
a. ABC License
$
b. Furniture/fixtures
$
c. Inventory
$
d. Goodwill/non-compete
covenant
$
e. Leasehold and/or Improvements
$
f. SUBTOTAL (Usually should equal the recorded notice)
$
g. Fees for other licenses, permits, and deposits (approximate). Include Federal, State,
County or City license fees or permits; lease and utility deposits
$
h. Working capital (approximate)
$
i. Realty or interest therein
$
0.00
j. TOTAL INVESTMENT (Items f through i) (will equal total of amounts listed in item #33)
$
34. Source of Funds for Total Investment (item #33j) - identify amount(s), type(s) and explain source(s) and/or terms of Repayment
Amount
Type
Source and/or Terms of Repayment
$1,000
Gift
John Doe, Brother
$15,000
Promissory Note
to seller, payable @ $1,000 per month for 15 months
$10,000
Loan
from ABC Bank, @ 8.5% over 5 yrs; monthly payment = $2,052
35. LIST ALL BANK ACCOUNTS FOR THIS BUSINESS OPERATION
BANK NAME
BANK ADDRESS
ACCOUNT NUMBER
a.
b.
c. NAMES OF ALL PERSONS AUTHORIZED TO SIGN ON BANK ACCOUNT(S) (Print)
I understand that falsification of the information on this form may constitute grounds for denial or revocation of the license(s).
For a period of 90 days from this date, I/we hereby authorize the Department of Alcoholic Beverage Control, or any of its officers,
to examine and secure copies of financial records consisting of signature cards, checking and savings accounts, notes and loan
documents, deposit and withdrawal records, and escrow documents of my/our financial institution(s) or any financial records
established in connection with this business. This authorization to examine records at any financial institution may be revoked at any
time. I/we also authorize the Department of Alcoholic Beverage Control, or any of its officers, to examine and secure copies of any
business records or documents established in connection with this business including, but not limited to those on file with my/our
bookkeeper. I/we also read all of the above and declare under penalty of perjury that each and every statement is true and correct.
36. APPLICANT SIGNATURE (Only one signature needed)
PRINTED NAME
DATE SIGNED
ATTEST (ABC Employee or Notary Public)
ABC-217 (rev. 01/19)
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