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

Cobb County Business License Division 7Alcoholic Beverage Establishment Change of Licensee ApplicationRevised 3/108. If Corporation or Limited Liability CompanyName of Corporation or LLC Name: ________________________________________________President/Member: ________________________________ Percentage of Ownership: _______Date of Birth: ______________________SS#: _______________________________________Home address: _____________________________ Home Phone: ________________________City: ____________________________, State: _______________________Zip: ____________Vice President/Member: _________________________Percentage of Ownership: ___________Date of Birth: ______________________SS#: _______________________________________Home address: _____________________________ Home Phone: ________________________City: ____________________________, State: _______________________Zip: ____________Secretary/Member: ___________________________Percentage of Ownership: _____________Date of Birth: ______________________SS#: _______________________________________Home address: _____________________________ Home Phone: ________________________City: ____________________________, State: _______________________Zip: ____________Treasurer/Member: __________________________Percentage of Ownership: ______________Date of Birth: ______________________SS#: _______________________________________Home address: _____________________________ Home Phone: ________________________City: ____________________________, State: _______________________Zip: ____________*Include additional partners/members on separate attachment9. List all stockholders by name, date of birth, social security number, address, phone number, andnumber of shares owned by each. Attach all stocks (front and back) to the application.Name DOB SSN Address Phone # #Shares____________________________________________________________________________________________________________________________________________________________________________________________________________________________________