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

Cobb County Business License Division 17Alcoholic Beverage Establishment Change of Licensee ApplicationRevised 3/1012. If married or separated, complete the following information on spouse.Full Name of Spouse ___________________________________________________________Social Security No.: _____________________Wife’s Maiden Name: ______________________Place of Birth: __________________________Date of Birth: ____________________________Place of Marriage: ________________________ Date of Marriage: _______________________U.S. Citizen by (please check one): Birth ______ Naturalized ______If naturalized: Certificate #_____________Date, place and court: _____________________________________ Petition #_____________Derived Parents Certificate #’S ____________________________________________________If not a citizen, please complete the following:Alien Registration #: __________________________ Native Country: ____________________Date and port of entry: __________________________________________________________*MUST PROVIDE ORIGINAL IMMIGRATION DOCUMENTS*Name of spouse’s employer: ______________________________________________________Address of employer: ____________________________________________________________13. Give names and addresses of all children and stepchildren (regardless of age).Full Name Address Age Place of Birth______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________