Ship Chandler Application Form. This is a Massachusetts form and can be use in Alcoholic Beverages Commission Statewide.
Tags: Ship Chandler Application, Massachusetts Statewide, Alcoholic Beverages Commission
Commonwealth of Massachusetts Alcoholic Beverages Control Commission 239 Causeway Street Boston, MA 02114 www.mass.gov/abcc The APPLICATION FOR A SHIP CHANDLER LICENSE MONETARY TRANSMITTAL FORM [APPLICATION MUST BE COMPLETED ONLINE] ECRT CODE: SHPC CHECK PAYABLE TO ABCC OR COMMONWEALTH OF MA: $1000.00 (CHECK MUST DENOTE THE NAME OF THE LICENSEE CORPORATION, LLC, PARTNERSHIP, OR INDIVIDUAL) CHECK NUMBER IF USED EPAY, CONFIRMATION NUMBER: A.B.C.C. LICENSE NUMBER (IF AN EXISTING LICENSEE): LICENSEE NAME: ADDRESS: CITY/TOWN: STATE LICENSE TYPE FEE SHIP CHANDLER $1.000.00 ZIP CODE # OF PERMITS 1 COST $1.000.00 YOU MUST MAIL THIS TRANSMITTAL FORM ALONG WITH YOUR CHECK AND COMPLETED APPLICATION TO: ALCOHOLIC BEVERAGES CONTROL COMMISSION P. O. BOX 3396 BOSTON, MA 02241-3396 American LegalNet, Inc. www.FormsWorkFlow.com Application for a Ship Chandler License M.G.L. Chapter 138, §13 YEAR 20 1. Applicant Information: Applicant Name: Business Name (d/b/a, if different) Address of Premises: Telephone: City/Town: State Zip E-mail Address 2. Description of Premises: Please provide a complete description of the premises from which alcoholic beverages are to be sold to vessels. 3. Licenses Issued by the United States Treasury: List type and number of license you hold (if any), issued by the Alcohol & Tobacco Tax and Trade Bureau (TTB) License Name and Number Type of License Pursuant to M.G.L. Ch. 62C, Sec. 49A, I certify under the penalties of perjury that, I have filed all state tax returns and paid all state taxes required under law. I further understand that each representation in this application is material to the determination of the application and state under penalty of perjury that all statements and representations therein are true. I hereby certify that the applicant is a ship chandler whose primary business is providing supplies and equipment to ships; I further certify that I have been in the ship chandler business in Massachusetts for at least one (1) year prior to the date of this application; I further certify that is a corporation organized under the laws of the Commonwealth and all its directors are citizens of the United States and a majority are residents of the Commonwealth and holds no other ship chandler license. Signature Date Title American LegalNet, Inc. www.FormsWorkFlow.com Ship Chandler Qualified Buyer Authorization Form To be completed at the time of each sale / purchase 5.05: Sales by Ship Chandlers (1) Sales may be made only between the hours of 8:00 A.M. and 11:00 P.M. Monday through Saturday. No sales or deliveries may be made on Sundays. (2) Sales may be made only to qualified buyers or their representatives. Qualified buyers must obtain Ship License Number from the Commission identifying them as such. A qualified buyer may authorize a Captain, Master or Ship's Officer to make purchases. (3) A licensee must see written proof that the person to whom a sale is made is a qualified buyer or authorized representative. The buyer must sign a statement under oath that he or she is a qualified buyer and that the alcoholic beverages purchased are solely for consumption on the vessel(s) he or she represents. I, owner/operator of the commercial vessel and/or shipping company operating out of the port of Commonwealth of Massachusetts, or my representative in the acting in my behalf is a qualified buyer in accordance with M.G.L., Chapter 138, §13 and Regulation 204 CMR 5:00. Signature Date of Purchase: American LegalNet, Inc. www.FormsWorkFlow.com