STATE OF WISCONSIN
Town of ________
________ County
In consideration of the payment of the $10.00 transfer fee, and on application of ________ ________, of the town, for a transfer of the [intoxicating liquor or fermented malt beverage] license to sell [describe class of license] at [describe premises now covered by the license], and consent of the licensee and the sureties having been given that the license bond shall cover the premises to which transferred, the license of ________ ________ is transferred from the premises now covered to the following described premises within the town: [describe premises to which the license will be transferred].
Dated this ______ day of ________, 20__.
[Signatures of town board]
Attest: [Signature of town clerk]
