State of West Virginia Department of Revenue Alcohol Beverage Control Administration 322 70th Street, SE Charleston, WV 25304-2900 INSTRUCTIONS FOR NON-RETAIL LIQUOR & WINE LICENSE APPLICATION (FORM ABCC-WS-3) APPLICANTS MUST TYPE OR PRINT, IN INK, ALL ANSWERS ON ALL FORMS 1. General Information - Please read all instructions carefully. All questions are to be answered in full. Your accuracy and thoroughness in completing the application form will assist us in processing the application and preventing unnecessary delays. 2. False representations made in application or failure to comply with chapter 60 of the West Virginia Code (State Code of Alcoholic Liquors) and rules and regulations promulgated thereunder may result in denial, revocation, or suspension of the license. 3. Any person holding any interest in a Wine Supplier, West Virginia Licensed Wine Distributor, or West Virginia Farm Winery may not hold any interest in a retail wine establishment or a private wine license. 4. Any person holding any interest in a West Virginia Distillery or a West Virginia Mini-Distillery may not hold any interest in a retail liquor, private club, or private wine restaurant establishment. 5. Licensing Periods: • • Wine Supplier, Wine Distributor, Farm Winery, and Direct Shipper license periods begin July 1 and end June 30 of each year. Distillery and Mini Distillery license periods begin January 1 and end December 31 of each year. 6. License fees must be paid by certified check, cashier’s check, company check, or money order payable to the West Virginia Alcohol Beverage Control Administration. Personal checks will not be accepted. If the license for a Wine Supplier, Wine Distributor, or Direct Shipper is issued for less than a full year, the fee may be prorated as follows: License Application Submitted License Fee July 1 through June 30 January 1 through June 30 Full License Fee ½ of License Fee 7. Documents which must accompany application: • • • • • • • If an Association – a copy of the Certificate of Authority and Agreement of Association If a Limited Liability Corporation – a copy of the Certificate of Authority and Articles of Organization If a Corporation – a copy of the Certificate of Authority and Articles of Organization A copy of the applicant’s federal basic permit, as required under the Federal Alcohol Administration Act A copy of West Virginia business license registration If out-of-state entity, a copy of current ABC license from state of domicile A Letter of Good Standing from the WV State Tax Department and if an out-of-state entity, a letter of good standing from the state of domicile (Forms to request a Letter of Good Standing from WV are included) • If applying as a resident Distillery or Mini Distillery–submit copies of all documents which have been submitted to the Trade Tax Bureau (TTB), along with documentation of the inspection report and approval American LegalNet, Inc. www.FormsWorkFlow.com 8. The application must be signed as follows and all signatures must be notarized: • • • • • If an individual, by the owner. If a Partnership/Limited Partnership, all partners If an Association, all members If a Corporation, president or vice president If a Limited Liability Corporation, all members if member managed/manager if manager managed 9. A farm winery license shall be issued only to, or held by, an applicant qualified to operate or who is operating a winery or wine cellar bonded under the laws and regulations of the United States. Form and instructions are available by calling the toll-free number at 800-937-8864 or available through download at the following website: http://www.ttb.gov/tax_audit/permits.shtml 10. All applicants must apply for a “Special Occupation Tax (TTB F 5630.5a)” with the Alcohol and Tobacco Tax and Trade Bureau. Form and instructions are available by calling the toll-free number at 800-937-8864 or available through download at the following website: http://www.ttb.gov/forms/5630d.pdf 11. Wine Supplier & Distributor Bonds – Please see bond instructions for proper completion. • • Wine Suppliers – Applicants must complete bond form ABCC-WS-3-B in the amount of $10,000. Wine Distributors – Applicants must complete bond form ABCC-WX-1-B in the amount of $10,000. 12. Direct Shippers must provide a list of brands that are to be shipped into West Virginia. Upon review of the list, if brands are not registered with the Commission, it is the responsibility of the Direct Shipper to register said brand(s). MAIL COMPLETED APPLICATION, FEES, AND REQUIRED ACCOMPANYING FORMS TO: West Virginia Alcohol Beverage Control Administration ATTN: Wine Licensing th 322 70 Street SE Charleston, WV 25304-2900 IF YOU HAVE ANY QUESTIONS OR NEED ASSISTANCE PLEASE CALL THE ADMINISTRATION AT 1-800-642-8208 OR (304) 558-2481 8:30AM-4:30PM EST AND ASK FOR WINE LICENSING. American LegalNet, Inc. www.FormsWorkFlow.com Form ABCC-WS-3 Revised 02/11 Licensing Period: __________to ___________ Applying As:  Individual  Partnership  Ltd. Partnership  Ltd. Liability Corp.  Corporation  Association License Number: ________________________ West Virginia Alcohol Beverage Control Administration th 322 70 Street, SE Charleston, WV 25304-2900 Non-Retail Liquor and Wine License Application  Wine Supplier  Distillery  Mini Distillery  Farm Winery  Multi Capacity  Wine Distributor  Direct Wine Shipper Questions 1 - 16 Questions 1 -16 Questions 1-16 Questions 1-16 Questions 1-16 Questions 1-16 Questions 1-16 License Fee $150 License Fee $1,500 Sections I & III Sections I & III License Fee $300 Sections I & II License Fee $50 License Fee $50 License Fee: $150 to ship < 14% Alc. Cont. $250 to ship > 14% Alc. Cont. License Fee $2,500 1. Business Entity Name ________________________________________ 2. FEIN __________________________________ 3. Business DBA Name _________________________________________ 4. Telephone _____________________________ 5. Business Physical Address _____________________________________________________________________________ (STREET) (CITY) (STATE) (ZIP CODE) 6. Business Mailing Address ______________________________________________________________________________ (STREET) (CITY) (STATE) (ZIP CODE) 7. Email ______________________________________________________ 8. Contact Person ________________________________________________ Telephone _____________________________ 9. Has applicant or any officer been: a. Convicted of a felony? When ____________________ If yes, attach written explanation. b. Convicted of a violation of federal or state alcohol laws? If yes, attach written explanation. c. Convicted of a criminal offense (misdemeanor) within the last 5 years? If yes, attach explanation. d. Refused any type of alcohol license or permit in any state? State ________ If yes, attach explanation. Yes Yes Yes Yes 10. Has applicant or any officer had: a. A hearing before the WVABCA Commissioner? If yes, attach written explanation. b. Any type of WVABCA license or permit sanctioned? If yes, attach written explanation. Yes  No  Yes  No      No No No No     Yes  No  11. Has applicant been refused any type of alcohol license or permit in any state? If yes, attach written explanation. 12. Does applicant, officers, directors or any blood relative hold any real estate, buildings, or equipment used by any WV retail licensee? If yes, attach a written explanation and provide name, address and interest. Yes  No  13. Does applicant, partner, member, stockholder, director, or any blood relative hold any interest in a licensed retailer in West Virginia? If yes, attach a written explanation and provide name, address and interest. Yes  No  14. Date and state your business incorporate or organized ______________________________________________________ Please include corporate charter or organization papers 15. If non-resident business, date of certificate of authority to do business in WV _____________________________________ Please include copy of certificate of authority 16. Supply the following information about the owners, officers, directors and manager: Title _______________________________ Title _______________________________ Title ______________________________ Name ______________________________ Name ______________________________ Name _____________________________ Res. Address ________________________ Res. Address ________________________ Res. Address _______________________ ___________________________________ ___________________________________ __________________________________ Telephone __________________________ Telephone __________________________ Telephone _________________________ % Ownership _______ DOB ____________ % Ownership _______ DOB ___________ % Ownership _______ DOB __________ SSN________________________________ SSN______________________________ SSN______________________________ WV Resident Y / N US CITIZEN* Y / N WV Resident Y / N US CITIZEN* Y / N WV Resident Y / N US CITIZEN* Y / N Use a separate sheet, if necessary. * If not a native US citizen, please attach a written explanation of when and where naturalized. American LegalNet, Inc. www.FormsWorkFlow.com SECTION I: To be completed by Wine Distributors, Farm Wineries, and Mini Distilleries. A. County which business is located _________________________________ B. Does the applicant own the premises to be licensed?  Yes  No If no, does applicant hold a valid lease?  Yes  No Expiration date of lease _______________________________ Property owner name/address _______________________________________________________________________ ________________________________________________________________________ C. Do the premises to be licensed conform to health, fire and zoning regulations?  Yes  No SECTION II: To be completed by Wine Distributors. A. Has applicant entered into any exclusive franchise agreement with a manufacturer, producer, processor, distributor, or supplier of wine whereby the applicant has been given the exclusive right within West Virginia or any given territory within West Virginia to distribute the product(s) of such manufacturer, producer, processor, distributor or supplier which are to be sold or distributed in West Virginia?  Yes  No If yes, please explain. ______________________________________________________________________________ SECTION III: To be completed by Farm Wineries and Mini Distilleries. A. Annual productive capacity is ______________________________ gallons. B. Is applicant, directly or indirectly, by means of signs, equipment, money, property or otherwise, giving aid to assistance to the holder of any retail beer or intoxicating liquor permit issued by the authority of this State?  Yes  No If yes, please explain. ______________________________________________________________________________ C. Does applicant own or control any real or personal property, which is rented, leased or used by the holder of any retail beer or intoxicating liquor permit issued by the authority of this State?  Yes  No If yes, please explain. ______________________________________________________________________________ D. Is your place of business in a section zoned by a county or municipality?  Yes  No If so, state district ___________ E. Give number and classification of former beer, wine, and spirituous liquor permits, if any.__________________________ F. Name nearest church or school and state distance in feet therefrom: __________________________________________ G. Is place of business located in business, residential or rural neighborhood? ____________________________________ Should the applicant fail to fully carry out and fulfill in every respect the laws of West Virginia, then the Commissioner shall have the right to terminate or revoke this license or permit and declare forfeited the penalty of the bond (if a bond is required for the selected license type). However, it is agreed and understood by and between the parties hereto that before such bond shall be forfeited a hearing shall be held in the Office of the West Virginia Alcohol Beverage Control Commissioner in the city of Charleston, West Virginia, after ten (10) days written notice to the applicant, setting forth the charge and the time and place of hearing thereon said notice shall be served the applicant by registered mail at the address hereinabove set forth. Instructions for signing: • If an individual, by the owner. • If a Partnership/Limited Partnership, all partners • If an Association, all members • If a Corporation, president or vice president • If a Limited Liability Corporation, all members if member managed/manager if manager managed NOTE: All changes in ownership interest during the license year must be reported immediately to the WV ABCA Commissioner. STATE OF ____________________, COUNTY OF __________________, to wit: In support of the foregoing application, the undersigned makes oath that the statements contained herein and all attachments are true to the best of his/her knowledge and belief. Date _____________________ Signature ______________________________________________ Title _________________ Date _____________________ Signature ______________________________________________ Title _________________ Date _____________________ Signature ______________________________________________ Title _________________ Date _____________________ Signature ______________________________________________ Title _________________ Given under my hand and official seal this_______ day of _________________________,___________. ___________________________________________________________________________________ Signature of Notary Public Commission Expires Seal of Notary American LegalNet, Inc. www.FormsWorkFlow.com State of West Virginia Department of Revenue Alcohol Beverage Control Administration 322 70th Street, SE Charleston, WV 25304-2900 Every person, company, or corporation intending to do business in West Virginia must register with the West Virginia State Tax Department. Additionally, corporations, limited partnerships and limited liability companies must register with the West Virginia Secretary of State. Please consult with the appropriate person (s) in your organization about compliance with the business registration requirements in West Virginia. Should further assistance be necessary, you may contact the following sources for registration information: West Virginia State Tax Department Taxpayer Services Division P.O. Box 3784 Charleston, WV 25337-3784 (304) 558-3333 or 1-800-982-8297 http://www.state.wv.us/taxrev/forms/2009/businessRegistration.booklet.pdf Secretary of State Corporations Division Capitol Complex Building 1, Room 151 1900 Kanawha Blvd. E. Charleston, WV 25305 (304) 558-8000 http://www.sos.wv.gov/business-licensing/business/Pages/businessdivision.aspx American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com