102-Department of Alcoholic Beverage Control Application.pdfDepartment of Alcoholic Beverage Control State of California
APPLICATION FOR ALCOHOLIC BEVERAGE LICENSES)
ABC 211 (6/99)
TO:Department of Alcoholic Beverage Control File Number: 501475
100 PASEO DE SAN ANTONIO Receipt Number: 2008252
ROOM 119 Geographical Code: 4303
SAN JOSE, CA 95113 Copies Mailed Date: July 14, 2010
(408) 277-1200 Issued Date:
DISTRICT SERVING LOCATION: SAN JOSS
First Owner: 7 ELEVEN INC
Name of Business: 7 ELEVEN STORE 2367-1432OF
Location of Business: 21220 HOMESTEAD RD
CUPERTINO, CA 95014
County:
Is Premise inside city limits?
Mailing Address:
(If different from
premises address)
Type of license(s): 20
.T
Yes
PO BOX 2245
BREA, CA 92822-2245
Census Tract 5083.03
Transferor's license/name: 372387 / 7 ELEVEN INC Dropping Partner: Yes No
License L= Transaction Type Fee Type Master Dug Date Fee
20 - Off -Sale Beer And wine FIDUCIARY TRANSFER NA Y 0 07/14/10 $50.00
Total $50.00
Have you ever been convicted of a felony? No
Have you ever violated any provisions of the Alcoholic Beverage Control Act, or regulations of the
Department pertaining to the Act? Yes
Explain any "Yes" answer to the above questions on an attachment which shall be deemed part of this application,
Applicant agrees (a) that any manager employed in an on -sale licensed premises will have all the qualifications of
a licensee, and (b) that he will not violate or cause or permit to be violated any of the provisions of the Alcoholic
Beverage Control Act.
STATE OF CALIFORNIA County of SANTA CLARA Date: July 14, 2010
Under penalty of perjury, each person whose signature appears below, certifies and says: (1) He is an applicant, or one of the applicants, or an executive officer
of the applicant corporation, named in the foregoing application, duly authorized to make this application on its behalf; (2) that he has read the foregoing and
knows the contents thereof and that each of the above statements therein made are true; (3) that no person other than the applicant or applicants has any direct
or indirect interest in the applicant or applicant's business to be conducted under the license(s) for which this application is made; (4) that -the transfer
application or proposed transfer is not made to satisfy the payment of a loan or to fulfill an agreement entered into more than ninety (90) days preceding the day
on which the -transfer application is filed with the Department or to gain or establish a preference to or for any creditor or transferor or to defraud or iniure any
creditor of transferor; (5) that the transfer application may be withdrawn by either the applicant or the licensee with no resulting liability to the Department.
Applicant Name(s) Applicant Signatures) ,
.7 ELEVEN INC See 211 Signature Page
11
OM KRISHNA INC
State of California
APPLICATION SIGNATURE SHEET ("SIGN ON')
Department of Alcoholic Beverage Control
• This form is to be used as the signature page for
applications not signed in the District Office, ❑Sole Owner _ Partnership -Ltd
• Read instructions on reverse before completing. Partnership Corporation
• All signatures must be notarized in accordance Married Couple Limited Liability Company
with laws of the State where signed.
Domestic Partner Other
2. FILE NUMaER (It any)
OriginalPerson to Person Transfer
Exchange Premise to Premise Transfer
20 Other self -incorporation
7-Eleven, Inc, and OM KRISHNA INC
6. APPLICANT'S MAILING ADDRESS (Street address/P.O. box, city, state, zip code)
P.O. Box 2245, Brea CA 92822-2245
7. PREMISES ADDRESS (Street address, city, zip code)
21220 Homestead Road, Cupertino CA 95014-0202
APPLICANT`S CERTIFICATION
Under penalty of perjury, each person whose signature appears
below, certifies and says: (1) He/She is an applicant, or one of
the applicants, or an executive officer of the applicant
corporation, named in the foregoing application, duly authorized
to make this application on its behalf; (2) that he/she has read the
foregoing and knows the contents thereof and that each of the
above statements therein made are true; (3) that no person other
than the applicant or applicants has any direct or indirect interest
in the applicant or applicant's business to be conducted under the
licenses) for which this application is made; (4) that the transfer
payment of a loan or to fulfill an agreement entered into more than
ninety (90) days preceding the day on which the transfer
application is filed with the Department, (b) to gain or establish a
preference to or for any creditor or transferor, or (c ) to defraud or
injure any creditor or transferor; (5) that the transfer application
may be withdrawn by either the applicant or the licensee with no
resulting liability to the Department.
I understand that if I fail to qualify for the license or withdraw
this application there will be a service charge of one-fourth of the
license fee paid, up to $100.
PARTNERSHIP/LIMITED PARTNERSHIP (Signatures of general partners only)
CORPORATION 7-Eleven, Inc.
10. PRINTED NAME (Last, arst, mlddte) oiuivr�i urcc
Smitha, Ena Williams X ,�Ki'� MAY 1mo
*PresidentVice President Chairman of the Board
PRINTM NAME (LesLnrst. middla5 ISIGNATURE 17 .i e ® e DATE SIGNED
Varela, Antonio Enrique
� Secretary Asst. Secretary Chief Financial Officer nAsst. Treasurer
LIMITED LIABILITY COMPANY
11. The limited liability company is member -run Yes No (If no, complete item #12 below)
12. NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Last, first, middle)
ABC-211-SIG (2(09) "SIGN ON"
State of California
County of Orange
On May 17, 2010
before me, Jill Jimenez, Notary Public
(insert name and title of the officer),
personally appeared Ena Williams Smitha I
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
per§on(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal.
JILL JIMENEZ
COMM.#1777883
0.
NOTARY PUBLIC *CALIFORNIA o
ORANGE COUNTY Y
Comm. Expires Nov. 4,2011
SIGNATURE ACKNOWLEDGEMENT FOR ABC DOCUMENTS
ABC-211-SIG ("SIGN -ON")
MARKET/STORE # 7-Eleven Store 2367-14320D
ADDRESS 21220 Homestead Road
Cupertino CA 95014-0202
APPLICANT (S): 7-Eleven, Inc.
Yoginder Pal Singal, President/Sec./Treasurer and
State of California }
} ss.
County of Alameda. }
and OM KRISHNA INC
On this the day ofbefore me,
Susan Curry Flores, Notary Public
the undersigned personally appeared,
Antonio Enrique Varela
Typed Name
who proved to me. on the basis of satisfactory evidence to be the person whose name(g) Ware
subscribed to the within instrument and acknowledged to me that he/#etWy executed the same in
his/*r/(their authorized capacity*, and that by hislholtF�Wir signature(O on the instrument the
person , or the entity upon behalf of which the persono)') acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal. SUSAN CURRY FLORES
COMM. #1823399 rn
W*,My
Notary PWo-Caiflomla T
ALAMEDA COUNTY
Conan. Exp, 0EC 1�7, 20t2
Notary's Signature Seal
Description of Attached. Document
Title or Type of Document: ABC-211-SIG ("SIGN -ON")
Capacity Claimed by Signer
Signer's Name: Antonio Enrique Varela
® Individual
N Corporate Officer —Title: Assistant Secretary
Signer is Representing: 7-ELEVEN INC
Stale of California
APPLICATION SIGNATURE SHEET ("SIGN ON")
Department of Alcoholic Beverage Control
• This form is to be used as the signature page.for sole Owner Partnership -Ltd
applications not signed in the District Office.
• Read instructions on reverse before completing. RN Partnership Corporation
• All signatures must be notarized in accordance Married Couple Limited Liability Company
with laws of the State where signed.
Domestic Partner Other
2. FILE NUMBER (it any) --ten.+. ... ....
Original Person to Person Transfer
Exchange Premise to Premise Transfer
20 Other self -incorporation
7-Eleven, Inc. and OM KRISHNA INC
6. APPLICANT'S MAILING ADDRESS (Street address/P.O. box, city, state, zip cede)
P.Q. Box 2245, Brea CA 92822-2245
7. PREMISES ADDRESS (Street address, city, zip code)
21220 Homestead Road, Cupertino CA 95014-0202
APPLICANT'S CERTIFICATION
Under penalty of perjury, each person whose signature appears
below, certifies and says: (1) He/She is an applicant, or one of
the applicants, or an executive officer of the applicant
corporation, named in the foregoing application, duly authorized
to make this application on its behalf; (2) that he/she has read the
foregoing and knows the contents thereof and that each of the
above statements therein made are true; (3) that no person other
than the applicant or applicants has any direct or indirect interest
in the applicant or applicant's business to be conducted under the
license(s) for which this application is made; (4) that the transfer
SOLE OWNER
payment of a loan or to fulfill an agreement entered into more than
ninety (90) days preceding the day on which the transfer
application is filed with the Department, (b) to gain or establish a
preference to or for any creditor or transferor, or (c ) to defraud or
injure any creditor or transferor; (5) that the transfer application
may be withdrawn by either the applicant or the licensee with no
resulting liability to the Department.
I understand that if I fail to qualify for the license or withdraw
this application there will be a service charge of one-fourth of the
license fee paid, up to $100,
PARTNERSHIPILIMITED PARTNERSHIP (Signatures of general partners only)
0
0
FA
Singal, Yoginder Pal
aPresident nvicePresident nChairmanofthe
Singal, Yoginder Pal
RN secretary F-]Asst, Secretary Chief Financial Officer
LIMITED LIABILITY COMPANY
0 L-, / I<,— / Zcn
NP I te,��-1 _b (")
11. The limited liability company is member -run Yes [] No (If no, complete Item #12 below)
12. NAME OF DESIGNATED MANAGER, MANAGING MEMBER OR DESIGNATED OFFICER (Last, first, middle)
ABC-211-SIG (2109) "SIGN ON"
SIGNATURE ACKNOWLEDGEMENT FOR ABC DOCUMENTS
ABC-211-SIG ("SIGN -ON")
MARKET/STORE # 7-Eleven Store 2367-14320D
ADDRESS 21220 Homestead Road
Cupertino CA 95014-0202
APPLICANT (S): 7-Eleven, Inc. and OM KRISHNA INC
Yoginder Pal Singal, President/Sec./Treasurer and
State of California }
} ss.
County of Alameda }
On this the t 4t' day of c� t,3Lk-q , �r 1, before me,
Susan Curry Flores, Notary Public
the undersigned personally appeared,
Yoginder Pal Singal
Typed Name
who proved to me on the basis of satisfactory evidence to be the person whose name(s) islWe
subscribed to the within instrument and acknowledged to me that he/s)i6/t executed the same in
his/,h-4/t ' authorized capacity f ), and that by his/ &/thdir signature(A) on the instrument the
person , or the entity upon behalf of which the person acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and offi 'areal SUSAN CURRY FLORES
COMM. #1823399 m
H Ndary Publlo-CalNon la
1 W ALAMEDA COUNTY ®°
My Comm. Exp. DEC 17, 2012
Notary's Signature Seal
Description of Attached Document
Title or Type of Document: ABC-211-SIG ("SIGN -ON")
Capacity Claimed by Signer
Signer's Name: Yoginder Pal Singal
® Individual
® Corporate Officer —Title: President/Secretary/Treasurer
Signer is Representing: OM KRISHNA INC