Department of Alcoholic Beverage Control PLANNED OPERATION (NON-RETAIL) 1. APPLICANT NAME(S) (Last, first, middle) 2. LICENSE TYPE(S) 3. PREMISES ADDRESS (Street number and name, city, zip code) 4. PREMISES (Check all that apply) Office Warehouse 5. MANUFACTURE Beer Production Facility Restaurant on Premises IMPORT Wine Distilled Spirits Tasting Room WHOLESALE (Distribute) Beer Wine Distilled Spirits Beer Wine Distilled Spirits 6. SELL TO Retailers Wholesalers 7. SURROUNDING AREA Export out of California Consumers 8. LOCATED ON 9. TYPE OF STRUCTURE Commercial Industrial Major Thoroughfare Single Story Residential Rural Secondary Street Two-Story Other: Multi-Story - Number of Stories: Other: 10. OPERATING HOURS Sunday Monday Tuesday Wednesday Thursday Friday Saturday Opening Time Closing Time 11. BRAND NAME(S) AND TYPE OF PRODUCT(S) (i.e., beer, wine, distilled spirits) WE WILL MANUFACTURE/IMPORT/DISTRIBUTE 12. SOURCE(S) OF SUPPLY OF ALCOHOLIC BEVERAGES AND SUPPLIER ADDRESS(ES) (Street number and name, city, state, zip code) 13. PRODUCT WILL BE SHIPPED TO ME/US VIA 14. MANUFACTURE GRAPE BRANDY Yes No 15. PRODUCT WILL BE SHIPPED TO MY/OUR CUSTOMERS VIA 16. PRODUCT WILL BE SHIPPED FROM (Street number and name, city, state, zip code) 17. PRODUCT WILL BE STORED AT (Street number and name, city, state, zip code) 18. BUSINESS RECORDS WILL BE MAINTAINED AT (Street number and name, city, state, zip code) 19. FEDERAL BASIC PERMIT REQUIRED FROM BUREAU OF ALCOHOL, TOBACCO & FIREARMS? IF YES, APPLICATION DATE Yes 20. BONDED WINERY PERMIT REQUIRED FROM BATF? Yes IF YES, APPLICATION DATE BONDED WINERY PERMIT NUMBER No 21. REGISTRATION REQUIRED FROM STATE BOARD OF EQUALIZATION? Yes BATF BASIC PERMIT NUMBER No IF YES, APPLICATION DATE No FOR ABC USE ONLY INFORMATION PROVIDED PROVIDED BY (Name) DATE PROVIDED ABC-578 Instructions to Beer Vendors ABC-413 Instructions to Distilled Spirits Shipper ABC-414 Distilled Spirits Shipper Agreement COMMENTS/ADDITIONAL INFORMATION ABC-257-NR (REVERSE) (10/08) American LegalNet, Inc. www.FormsWorkFlow.com