APPLICATION FOR DIRECT SHIPMENT OF WINE Department of Liquor Control County of Maui 2145 Kaohu Street, Room 105 Wailuku Hawaii 96793 TEL: 808-243-7753 FAX: 808-243-7558 Submit this form to the Department. Include with application: • Copy of TTB Basic Permit • Copy of current winery license • Copy of State of Hawaii General Excise License • Payment in check or money order payable to: Department of Liquor Control Fee Schedule: Jan $48.00 Apr $36.00 Jul $24.00 Oct Feb $44.00 May $32.00 Aug $20.00 Nov Mar $40.00 Jun $28.00 Sep $16.00 Dec $12.00 $8.00 $4.00 PERMIT YEAR 1. APPLICANT NAME(S) (This should be the same as the name on the winery license) 2. PHONE NUMBER (including area code) 3. PREMISES ADDRESS (Street number and name, city, state and zip code) 4. FAX NUMBER (including area code) 5. BUSINESS NAME (DBA) 6. BUSINESS MAILING ADDRESS (if different from #3 above) (Street number and name, city, state and zip code) 7. STATE WHERE CURRENTLY LICENSED 8. LICENSE NUMBER 11. AUTHORIZED SIGNATURE 9. EXPIRATION DATE 12. PRINTED NAME 10. TYPE OF LICENSE ISSUED (i.e. winegrower) 13. DATE SIGNED HAWAII REVISED STATUTES "§281- 33.6 Direct shipment of wine by wineries. (2) Require that the carrier of the shipment obtain the signature of any person twenty-one years of age or older before delivering the shipment; (a) Any person holding: (3) Report no later than January 31 of each year to the liquor commission in each county where a direct wine shipper permit is held, the total amount of wine shipped to persons in the county during the preceding calendar year; (1) A general excise tax license from the department of taxation; and (2) Either: (A) A class 1 license to manufacture wine under section 281-31; or (4) Pay all applicable general excise and gallonage taxes. For gallonage tax purposes, all wine sold under a direct wine shipper permit shall be deemed to be wine sold in the state; and (B) A license to manufacture wine issued by another state, may pay any applicable fees and obtain a direct wine shipper permit from the liquor commission of the county to which the wine will be shipped authorizing the holder to directly ship wine to persons in the county pursuant to this section. (5) Be subject to audit by the liquor commission of each county in which a permit is held. (b) The holder of a direct wine shipper permit may sell and annually ship to any person twenty-one years of age or older in the county that issued the permit, no more than six nine-liter cases of wine per household for personal use only and not for resale, and shall: (1) Ship wine directly to the person only in containers that are conspicuously labeled with the words: "CONTAINS ALCOHOL: SIGNATURE OF PERSON AGE 21 YEARS OR OLDER REQUIRED FOR DELIVERY."; (c) The holder of a license to manufacture wine issued by another state may annually renew a direct wine shipper permit by providing the liquor commission that issued the permit with a copy of the license and paying all required fees. The holder of a class 1 license to manufacture wine under section 281-31 may renew a direct wine shipper permit concurrently with the class 1 license by complying with all applicable laws and paying all required fees. (d) The sale and shipment of wine directly to a person in this state by a person that does not possess a valid direct wine shipper permit is prohibited. Knowingly violating this law is a misdemeanor. (e) The liquor commissions in each county may adopt rules and regulations necessary to carry out the intent and purpose of this section." FOR DLC USE ONLY ATTACHMENTS RECEIVED Copy of current alcoholic beverage license Payment Copy General Excise License Copy of TTB Basic Permit & registered trade names DIRECTOR RECOMMENDATION Approved DATE Denied Permit No. DLC-019 [rev02/07] American LegalNet, Inc. www.FormsWorkflow.com