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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
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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
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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:
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