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

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Cobb County Business License Division 24Alcoholic Beverage Establishment Change of Licensee ApplicationRevised 3/10Updated 7/1/08Metro AtlantaDept. of Motor VehiclesMariettaMarietta1605 County Services Pkwy 2800 Canton Road, Suite 1000Marietta, GA 30008 Marietta, GA 30066770-528-3250 770-528-5401CantonCarrollton1085 Marietta Highway 512 Old Newnan RoadCanton, GA 30114 Carrollton, GA 30117770-720-3693 770-836-4603Forest Park5036 Georgia Highway 85Forest Park, GA 30297404-669-3961Lawrenceville310 Hurricane Shoals RoadLawrenceville, GA 30045770-995-6890Cartersville1300 Joe Frank Harris ParkwayCartersville, GA 30120770-387-3700
Cobb County Business License Division 25Alcoholic Beverage Establishment Change of Licensee ApplicationRevised 3/10OWNER/LICENSEE PERSONAL FINANCIAL STATEMENT (Confidential)Name`Social Security No.Residence AddressCity, State, ZipDate of BirthName of SpouseBusiness or OrganizationBusiness PhoneResidence Phone Partner or Officer in any other business? ( ) Yes ( ) NoAssetsCash on hand and in banksAccounts receivableNotes receivableStocks and BondsReal EstateCash value of life insuranceAutomobiles% Interest LiabilitiesNotes Payable to Banks-SecuredNotes Payable to Banks-UnsecuredNotes Payable to OthersAccounts PayableUnpaid TaxesMortgages on Real EstateOther DebtsDeposit accountsCredit with financial institutionsOther assets (itemize):Total LiabilitiesNet WorthTotal AssetsTotal Liabilities and Net WorthSource of Annual IncomeSalaryBonus and CommissionsDividendsAlimony, child support, or separate incomeItemize all loan sources and interest:Other income (itemize)TotalGeneral InformationUnsatisfied judgments or law suits pending? Yes ( ) NoAre any income tax returns made by you for prior years being contested?( ) Yes ( ) NoIf so, what do you estimate as the additional amount you may be required topay?Are any assets pledged or in joint names other than as described above?( ) Yes ( ) NoHave you ever been declared bankrupt? Yes ( ) NoDo you have a will? Yes ( ) No Beneficiary(ies): Who is named as your executor?As of , 20 .
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Cobb County Business License Division P.O. Box 649 Marietta ...

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