Cobb County Business License Division 1 New Alcoholic Beverage ...
Cobb County Business License Division 1 New Alcoholic Beverage ...
Cobb County Business License Division 1 New Alcoholic Beverage ...
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<strong>Cobb</strong> <strong>County</strong> <strong>Business</strong> <strong>License</strong> <strong>Division</strong> 18<strong>New</strong> <strong>Alcoholic</strong> <strong>Beverage</strong> Establishment ApplicationRevised 3/10Owner/ <strong>License</strong>e Personal Statement(A photo of applicant must be attached)Attach2X2PhotosHere1. Full name of owner/licensee (Do Not UseInitials)_____________________________________Include maiden name(s), alias(s), etc.2. Social Security No. ____________<strong>Business</strong> Phone___________ Cell Phone_________________3. Home Address: _______________________________________ Home Phone ______________(include city, state and zip)4. <strong>Business</strong> Address: ______________________________________________________________(include city, state and zip)5. Race: _______ Sex: ______________ Height: __________________Weight:_______________Age: ________ Color of Hair: ______________Color of Eyes: ___________________________6. Place of Birth: __________________________Date of Birth: ____________________________U.S. Citizen by (please check one): Birth ____ Naturalization ____ Not a Citizen ____If naturalized:Certificate # ____________________Date, Place, and Court: __________________________________Certificate #______________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*7. How long have you resided in the State of Georgia? ___________________________________8. Number of years resided at your present address? ____________________________________9. What has been your occupation for the past five (5) years?______________________________10. What is your position title with the business submitting this license application? __________________________________________________________________________________________11. Are you: (Circle one)Single Married Widowed Divorced Separated
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