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> 24<strong>New</strong> <strong>Alcoholic</strong> <strong>Beverage</strong> Establishment ApplicationRevised 3/10TO BE COMPLETED BY THE LICENSEE, SPOUSE OF LICENSEE, OWNERS ANDSPOUSES, PARTNERS AND SPOUSES AND STOCKHOLDERS WITH 20% OR MORE OFSHARES AND THEIR SPOUSES.CONSENT FORMI HEREBY AUTHORIZE COBB COUNTY BUSINESS LICENSE TO RECEIVE ANYCRIMINAL HISTORY RECORD INFORMATION PERTAINING TO ME WHICH MAY BE INTHE FILES OF ANY STATE OR LOCAL CRIMINAL JUSTICE AGENCY IN GEORGIA.____________________________________FULL NAME PRINTED____________________________________STREET ADDRESS_____________________________________CITY, STATE, & ZIP_________ _________ ___________________SEX RACE DATE OF BIRTH________________________SOCIAL SECURITY NUMBER_________________________________ALIEN NUMBER (IF NOT A US CITIZEN)______________________________________SIGNATURE__________ __________________NOTARY PUBLIC_______________________DATE
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