Supplement For Wine Sellers Permit Application Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Supplement For Wine Sellers Permit Application Form. This is a Indiana form and can be use in Alcohol And Tobacco Commission Statewide.
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Tags: Supplement For Wine Sellers Permit Application, Indiana Statewide, Alcohol And Tobacco Commission
302 West Washington Street
IGCS Room E114
Indianapolis, IN 46204
STATE OF INDIANA
ALCOHOL AND TOBACCO COMMISSION
Telephone 317 / 232-2430
Fax 317 / 233-6114
www.IN.gov/atc
SUPPLEMENT FOR DIRECT WINE SELLER’S PERMIT APPLICATION
The applicant, ___________________________, seeks a Direct Wine Seller’s Permit under
Indiana Code 7.1-3-26. The applicant:
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is domiciled and has its principal place of business in the United States;
is engaged in the manufacture of wine;
holds and acts within the scope of authority of an alcoholic beverage license or permit to
manufacture wine that is required by Indiana or the state in which the applicant is
domiciled and by the Tax and Trade Bureau of the United States Department of the
Treasury;
qualifies with the Indiana Secretary of State to do business in Indiana;
consents to the personal jurisdiction of the Indiana Alcohol & Tobacco Commission and
the Indiana courts;
The applicant files a surety bond with the commission in accordance with IC 7.1-3-1;
does not hold a permit to wholesale alcoholic beverages issued by any authority and is
not owned in whole or in part or controlled by a person who holds a permit or license to
wholesale alcoholic beverages;
sells not more than five hundred thousand (500,000) gallons of wine per year in Indiana,
excluding wine shipped to an out-of-state address;
has not distributed wine through a wine wholesaler in Indiana within the one hundred
twenty (120) days immediately preceding the applicant's initial application for a direct
wine seller's permit or the applicant has operated as a farm winery under IC 7.1-3-12;
and
is not the parent, subsidiary, or affiliate of another entity manufacturing any alcoholic
beverage.
I certify that this supplement was completed by myself and that any attachments are true and
correct. I UNDERSTAND THAT IT IS A FELONY TO MISREPRESENT OR FALSIFY
ANY PORTION OF THIS APPLICATION OR ATTACHED DOCUMENTS.
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Applicant’s Signature
___________________________
Date
Applicant’s Name ______________________________
d/b/a: ________________________________________
Address: _____________________________________
_____________________________________________
Phone Number: ________________________________
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