Gifts And Loans From Wholesalers Disclosure Form
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Gifts And Loans From Wholesalers Disclosure Form. This is a District Of Columbia form and can be use in Alcoholic Beverage Regulation Administration Statewide.
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GOVERNMENT OF THE DISTRICT OF COLUMBIA Alcoholic Beverage Regula on Administra on 23 DCMR �� 903 and 904 Gifts and Loans from Wholesalers and Manufacturers Disclosure Form Name of entity contributing the item or service. Mail Alcoholic Beverage Regulation Administration Attn: Licensing Division 2000 14th Street, NW, Suite 400 South Washington, D.C. 20009 Fax 202.442.9563 Email MyABCLicense.ABRA@DC.gov Board approval is not required for an individual transmittal having a value of less than fifty dollars ($50). Date of Event: _______________________ From: _______________________ (License No.) _______________________ (Trade Name) _______________________ (Address) A. The applicant requests permission to distribute the following item or service to licensees: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ B. The item/service is a (check one): C. Value of item: $ _______________ Purchase Rental Loan Gi D. Each License listed has received the exact same item/service as described above: Yes Yes No No E. The service or ar cle of property does not exceed $500.00 for each individual occurrence: F. List the name of Licensee(s) receiving the item or service described above. License Number Trade Name Address Signature: ___________________________________ Date: ___________________ American LegalNet, Inc. www.FormsWorkFlow.com
