Cobb County Business License Division P.O. Box 649 Marietta ...

Cobb County Business License Division 15Alcoholic Beverage Establishment Change of Licensee ApplicationRevised 3/10GEORGIA, COBB COUNTYI, ____________________________ SWEAR THAT THE FACTS AND STATEMENTSSTATED BY ME IN THE ABOVE AND FOREGOING ANSWERS ARE TRUE AND COMPLETE, AND THAT NOFALSE OR FRAUDULENT STATEMENTS ARE MADE HEREIN, AND NO FALSE OR FRAUDULENT STATEMENTOR STATEMENTS HAVE OR WERE MADE IN ORDER TO PRODUCE THE GRANTING OF AN ALCOHOLICBEVERAGE LICENSE.I FURTHER CERTIFY THAT I WILL NOTIFY COBB COUNTY BUSINESS LICENSE DIVISIONOF ANY CHANGE IN MANAGEMENT, LICENSEE, OR OWNERSHIP IMMEDIATELY.________________________SIGNATURE OF APPLICANTSWORN TO AND SUBSCRIBED BEFORE ME THIS _______ DAY OF ___________,20____________________________NOTARY PUBLIC________________________SIGNATURE AND TITLE OFPERSON OTHER THAN APPLICANTFILLING OUT THIS APPLICATION.__________________________TELEPHONE NUMBERALL QUESTIONS MUST BE ANSWEREDRECEIVED IN COBB LICENSE DEPARTMENT ON________________ AT_____________BY_____________________________BUSINESS LICENSE CLERK___________________________________DATE