Source of Funds Statement

This form is required when applying for a Gambling or Liquor license.

Gambling license

A separate Source of Funds Statement must be submitted by EACH of the following business types:

Corporation
Partnership
Limited partnership
Limited liability partnership
Limited liability corporation

AND
A separate Source of Funds Statement must be submitted by EACH of the following individuals:

Sole proprietor
Corporate officer
Partner or limited partner
Financier
Limited liability corporation member
Stockholders that hold 10% or more ownership in the firm

Liquor license

Liquor Control Board will determine who must complete a Source of Funds Statement. If you are applying for a Liquor license and have any questions, please contact the Customer Service Division of the Liquor Control Board at (360) 664-1600.

Instructions

Please fill out the form completely and print it on white paper. Send the completed statement with your license application to:

Master License Service
Department of Licensing
PO Box 9048
Olympia, WA 98507-9048
Fax: (360) 570-7875

Open the Source of Funds Statement form.

Please remember to enclose all necessary documents and fees with your completed application. Your license may be delayed if your application is incomplete. It is important that you contact our office, in writing, with any changes in address.

Questions?

For help filling out this form, please call us at (360) 664-1400.