APPLICATION FOR CARRIER'S ALCOHOLIC PERMIT ALCOHOL & TOBACCO COMMISSION State From 47242 (12-95) / Form 601 302 W. Washington Street, Room E114 Indianapolis, IN 46204 Approved by State Board of Accounts 1995 http://www.IN.gov/atc NOTE: This application must be filed and accompanied by the proper fee of $5.00 / Cashier's Check, Certified Check, or Money Order. To the Indiana Alcohol & Tobacco Commission: The undersigned individual (Type full name of applicant.) general partnership limited partnership corporation limited liability corporation hereby makes application for a Carrier's Alcoholic Beverage Permit to entitle said applicant to haul, convey, move, transport, or import alcoholic beverages along or over public highways of this state, under and subject to the provisions of Indiana Code 1971, I.C. 7.1-3-18-1 through 7.1-3-18-6. The applicant consents, that for the duration of the permit term, if issued, to the entrance, inspection, and search by a law enforcement officer, without a warrant or other process of his licensed premises and vehicles within Indiana to determine whether he is complying with the provisions of the alcoholic beverage laws and rules and regulations of Indiana. The applicant further consents to keep the proper identification tag or label displayed upon each motor vehicle to which this application applies, and the descriptions of which are attached hereto and made part o hereof, and also upon each motor vehicle registered with the Commission under this permit. The applicant further states, and warrants as true, the descriptions of motor vehicles desired to be covered by this permit as attached hereto and likewise warrants as true the following information: 1. If the applicant is an individual or general partnership, state name and residence address of yourself and each partner: Name Address (number and street, city, state, ZIP code) Name Address (number and street, city, state, ZIP code) Name Address (number and street, city, state, ZIP code) 2. If the applicant is a corporation, limited partnership, or limited liability company, give date of incorporation or organization, state in which incorporated or organized, and location of principal place of business: Date of incorporation State in which incorporated Location of principal place of business 3. If a corporation, all of the following that apply limited partnership or limited liability company, give names and addresses of president, secretary, resident agent: Name of president Address (number and street, city, state, ZIP code) Name of secretary Address (number and street, city, state, ZIP code) Name of registered agent Address (number and street, city, state, ZIP code) Name of general partner(s) Address (number and street, city, state, ZIP code) Name of LLC members Address (number and street, city, state, ZIP code) Name of limited partner(s) Address (number and street, city, state, ZIP code) Name Address (number and street, city, state, ZIP code) Name Address (number and street, city, state, ZIP code) Name Address (number and street, city, state, ZIP code) American LegalNet, Inc. www.FormsWorkflow.com 4. How long have you been engaged in the business of a common carrier, or carrier for hire? 5. How many vehicles or conveyances do you operate in connection with your business, including the transportation of merchandise other than alcoholic beverages? 6. If you do not own all the vehicles, give names and addresses of owners and state fully your interest in such vehicle or vehicles and the nature of the arrangements between yourself and the owner thereof: 7. I have read, understand and have made true answers to each of the above questions. Signature of applicant (if individual) or corporate or partnership name By: (Signature of officer, agent, or partnership) State of SS: County of Subscribed and sworn to before me by the above named (Name of individual, officer, agent, or partner) this _________________________________ day of __________________________ , 20 ____________ . SEAL County of residence Signature of Notary Expiration date of commission Name of Notary (typed or printed) CHAPTER 18 SPECIAL PERMITS SECTION. 7.1-3-18-1. 7.1-3-18-2. 7.1-3-18-3. 7.1-3-18-4. Carrier's alcoholic permit - Issuance authorized. Scope of carrier's alcoholic permit. Highway transportation - Carrier's permit required. Beer for consumption out of state - Carrier's permit not required. SECTION. 7.1-3-18-5. 7.1-3-18-7. 7.1-3-18-8. Prerequisite to issuance of carrier's alcoholic permit Vehicle description. Salesman's permit- Issuance authorized - Application Contents. Scope of salesman's permit. 7.1-3-18-1. Carrier's alcoholic permit - Issuance authorized. The commission may issue a carrier's alcoholic permit to a person who is a carrier upon showing of the and responsibility of the carrier and the propriety of issuing the permit. The commission may issue a carrier's alcoholic permit without publication of notice and investigation by a local board. [IC 7.1-3-18-1, as added by Acts 1973, P.L. 55 & 1.] 7.1-3-18-2. Scope of carrier's alcoholic permit. A carrier shall be required to apply for, and be applicable to, the movement, conveyance, importation, and transportation of alcohol and alcoholic beverages on a public highway in this state. A carrier's alcoholic permit shall not be required when the conveyance, movement, importation, or transportation is conducted by means of cars or trains operated by a railroad of any type over fixed rails. [IC 7.1-3-18-2, as added by Acts 1973, P.L. 55 & 1.] 7.1-3-18-3. Highway transportation - Carrier's permit required. A carrier shall be required to apply for, and obtain a carrier's alcoholic permit before he may haul, convey, transport, or import alcoholic beverages on a public highway of this state or a crossing boundary of it. [IC 7.1-3-17-3, as added by Acts 1973, P.L. 66 &1.] 7.1.2-18-4. Beer for consumption out of state - Carrier's permit not required. A carrier who transports beer manufactured in Indiana for consumption outside this state shall not be required to obtain a carrier's alcoholic permit if the beer has been manufactured under a brewer's permit and if in the judgment of the commission, through safeguards provided by the cooperation of the brewer, the issuance of a permit to the carrier is not necessary to protect the interests of the State of Indiana. [IC 7.1-3-18-4, as added by Acts 1973, P.L. 55 & 1.] 7.1-3-18-5. Prerequisite to issuance of carrier's alcoholic permit - Vehicle description. A carrier's alcoholic permit shall not be operative as to a vehicle owned or operated by the carrier and shall not authorize the transportation or conveyance of alcoholic beverages in it unless a description of the vehicle is first filed with the commission. The description of the vehicle shall include the engine number, date of manufacture, approximate weight, motor vehicle number, all license plate numbers, capacity, and any other information that the commission may require. The filing of the required information shall include that vehicle in the coverage of the permit. The permittee may alter or add to the number of vehicles included under the permit from time to time. [IC 7.1-3-18-5, as added by Acts 1973, P.L. 55 &1.] American LegalNet, Inc. www.FormsWorkflow.com