NEVADA DEPARTMENT OF TAXATION 1550 E. COLLEGE PARKWAY STE. 115 CARSON CITY NV 89706 (775) 684-2125 LIQUOR WHOLESALER DESIGNATION AND ACCEPTANCE FORM 1. SUPPLIER: Must be the original owner/manufacturer or designated agent (appointment must be attached before submitting this form). (Supplier's Firm Name) (Taxpayer ID Number) (Mailing Address) (City, State, Zip Code) Pursuant to NRS 369.386, the above named supplier hereby appoints to receive shipments of alcoholic beverages under the following list of brand names: 1. 3. 2. 4. (Attach additional sheets if necessary) (Nevada Importer/Wholesaler, City ­ One Location Per Form) 2. I have appointed the following person as resident agent in the State of Nevada upon which any service or process or any notice may be served pursuant to NRS 369.430. (May be Nevada Importer/Wholesaler.) Agent's Name: Agent's Address: I certify I will notify the Department of Taxation, Liquor Division, of any changes regarding the above appointments. Date: Title: (Supplier) Name in print: Signature: PLEASE FORWARD TO NEVADA IMPORTER/WHOLESALER AFTER COMPLETING SUPPLIER PORTION AND ATTACHING ALL REQUIRED DOCUMENTATION 3. WHOLESALER: hereby accepts the appointment from (Importer/Wholesaler) to receive the above listed brands per NRS 369.386. (Name of Supplier) Date: Authorized signature: (Nevada Importer/Wholesaler) PLEASE COMPLETE AND RETURN TO THE DEPARTMENT OF TAXATION AFTER SUPPLIER AND NEVADA IMPORTER/WHOLESALER HAVE SIGNED American LegalNet, Inc. www.FormsWorkFlow.com LT 08 Revised 5-21-14 INSTRUCTIONS FOR COMPLETING THE LT 08 LIQUOR WHOLESALER DESIGNATION AND ACCEPTANCE FORM A supplier of alcoholic beverages (liquor) must be registered with the Nevada Department of Taxation (Department) and hold a current Certificate of Compliance. A completed and signed Wholesaler Designation and Acceptance form (LT 08) must be filed with the Department prior to shipment of liquor. Sales or shipments of liquor to Nevada may be made only to licensed liquor importer/wholesaler warehouses or bonded free-trade warehouses. Please read: NRS 369.386 Suppliers of liquor: Conditions for selling to importer; designation of importer and agent. 1. Except as otherwise provided in NRS 369.464, a supplier of liquor may sell to an importer into this state only if: (a) Their commercial relationship is of definite duration or continuing indefinite duration; and (b) The importer is granted the right to offer, sell and distribute within this state or any designated area thereof such of the supplier's brands of packaged malt beverages, distilled spirits and wines, or all of them, as may be specified. 2. The supplier shall file with the department a written notice indicating the name and address of each designated importer. Each importer shall file with the department a written acceptance of the designation. 3. A brewer, distiller, manufacturer, producer, vintner or bottler of liquor who designates an agent to sell his products to importers into this state shall file with the department a written designation indicating the name and address of the agent, and the agent shall file with the department a written acceptance of the designation. (Added to NRS by 1981, 1009; A 1999, 2104) The supplier is to complete sections 1 and 2. A separate form for each wholesaler location is required. Brands, not labels, must be specified, see 1(b) above. A resident agent must be appointed pursuant to NRS 369.430, 4(d), and may be the Nevada Liquor Importer/wholesaler. An officer of the supplier company or corporation must state his/her title, print and sign their name and insert the correct date on each LT 08. If the signature is of anyone other than an officer, an appointing power of attorney must accompany the LT 08, signed by an officer of the supplier company or corporation. If the supplier company is acting as agent for the original owner/manufacturer, an appointment of the supplier company, on original owner letterhead, signed by an officer must be attached. An acceptance of the appointment on supplier company letterhead must be attached. See 3 above. The original LT 08 will be forwarded to the importer/wholesaler(s) for completion and signing of section 3. A copy should be maintained by the wholesaler, and the original mailed to the Department, with original attachments. Additional Importer/wholesalers or additional brands require additional LT 08 forms. American LegalNet, Inc. www.FormsWorkFlow.com