Cobb County Business License Division 1 New Alcoholic Beverage ...

Cobb County Business License Division 9New Alcoholic Beverage Establishment ApplicationRevised 3/108. If Corporation or Limited Liability CompanyName of Corporation or LLC: _____________________________________________________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 attachment*9. List all stockholders by name, date of birth, social security number, address, phone number, andnumber of shares owned by each. Attach copies of all stock certificates (front and back) to theapplication.Name DOB SSN Address Phone # #Shares____________________________________________________________________________________________________________________________________________________________________________________________________________________________________