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WITHOUT THIS INFORMATION THE DIVISION WILL BE UNABLE TO PROCESS YOUR CANCELLATION AND/OR SUBMIT A REFUND IF APPLICABLE. Print Name Telephone Number Social Security Number Mailing Address City State DLC 4260 EOE/ADA SERVICE PROVIDER Zip Code FOR TTY USERS DIAL ORS 1-800-750-0750 Rev. 11/10/2016. Ohio Department of Commerce Division of Liquor Control 6606 Tussing Road P. O. Box 4005 Reynoldsburg OH 43068-9005 614 644-3155 FAX 614 644-3166 http //www. /s/ Skip Section B and complete Section C...
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