ABCD 2000RN (REVISED 9/02) APPLICATION, RENEWAL ALCOHOLIC BEVERAGE RETAILER’S PERMIT RETURN TO ALCOHOLIC BEVERAGE CONTROL DIVISION PERMIT DEPARTMENT P.O. BOX 540 MADISON, MS. 39130-0540 American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS FOR PROPER FILING OF YOUR RENEWAL APPLICATION PLEASE READ PRIOR TO COMPLETING THIS FORM 1. Each applicant, regardless of the type of permit to be renewed, must complete Items I through VII of this application. Private Clubs and Corporations must include each officer’s name and social security number. On-premise retailer’s not located within a qualified resort area must complete the supplemental income summary, Item VIII. 2. Each of your alcoholic beverage managers must apply for an Identification card as required by ABC Reg. 39. Please contact this office at 601-856-1330 for application forms. 3. If you have failed to file your Sales Tax, Income Tax, or any other tax returns when due, you may contact the State Tax Commission Office in your area for assistance. When you have filed and paid any taxes due, please request the State Tax Commission to contact our office at 601-856-1330 to verify that your filing status is current. We must have this information in order to continue to process your application. 4. Include your renewal fees with your application. NOTE: IF YOU ARE REQUIRED TO 5. Only the owner, if a sole ownership, a partner, if a partnership, or an officer, if a corporation, may sign this application. MANAGERS CAN NOT SIGN YOUR RENEWAL FORM. The signature must be notarized by a licensed Notary Public. 6. Include a copy of your current lease or deed to the property. If you lease the business premises, the lease you submit must be valid through your permit year. If you have already submitted a copy of your deed, you may submit a letter stating that your existing deed is unchanged. 7. Include either a copy of your current Federal retailer’s stamp or a copy of your receipt or cancelled check as proof of purchase of same. 8. This application must be filed by you thirty (30) days prior to the expiration of your permit. 9. Holders of a Wholesale Permit are required to submit an additional renewal application when renewing their Package Retailer permit. 10. If you have made any changes to your ABC Permit during the previous renewal year, you are required to have these changes approved by the Commission before your permit will be renewed for the new year. Examples are change in your Corporate Officers, change in your LLC, etc. SUBMIT CERTIFIED FUNDS FOR PAYMENT OF YOUR ALCOHOLIC BEVERAGES, YOUR RENEWAL FEES MUST BE PAID WITH CERTIFIED FUNDS. DO NOT SEND CASH THROUGH THE U.S. MAIL. WE DO NOT DRAFT ACCOUNTS FOR RENEWAL FEES. If you have questions, or need assistance, please contact Permit Department, Renewal Desk At 601-856-1330 American LegalNet, Inc. www.FormsWorkflow.com (REVISED 02/03) PERMIT DEPT. USE ONLY AMT. OF CHECK CHECK NUMBER PERMIT NUMBER APPLICATION FOR RENEWAL OF ABC PERMIT I. APPLICANT: (Name of sole owner, partnership, or corporation) Tradename: Expiration Date: Permit Number: Address: (street) Business Location: (city) inside city Home Address: (street/p.o.box) II. III. LICENSE TYPE (zip) (county) outside city Telephone Numbers: (b) (h) (city) Class I Manufacturer, Distiller & Rectifier................................. Class II Manufacturer, Wine Manufacturer............................... Class III Manufacturer, Native Wine........................................ Native Wine Retailer.............................................................. Package retailer..................................................................... On-premise retailer ............................................................…. On-premise retailer, Wine Only............................................... On-premise retailer, Club....................................................... Caterer’s, for on-premise retailer’s........................................... Caterer’s................................................................................ Common Carrier..................................................................... Solicitor’s............................................................................... Research............................................................................... Alcohol processor................................................................... Wholesaler retailer................................................................. (state) ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) (zip) FEE AMOUNT $ 9,025.00 3,625.00 45.00 125.00 1,825.00 925.00 475.00 475.00 325.00 1,225.00 145.00/120.00 125.00 125.00 25.00 000.00 LIST YOUR TAXPAYER IDENTIFICATION NUMBERS: 1. Sales Tax Number: 2. Social Security Number: NOTE: For partnership, provide each partner’s name and social security number. (Use separate page if more space is needed). NOTE: For corporation or private club, provide each officer’s name, title and social security number. (Use separate page is more space is needed). IV. _ HAS THERE BEEN ANY CHANGE IN YOUR PERMIT DURING THE PAST YEAR If “yes” explain fully: (OWNERSHIP, OFFICERS, LOCATION, ETC)? American LegalNet, Inc. www.FormsWorkflow.com V. HAVE ALL YOUR ALCOHOLIC BEVERAGE MANAGERS APPLIED FOR AN IDENTIFICATION CARD, AS REQUIRED BY ABC REG. NO. 39? YES NO MANAGER(S) NAME AND SOCIAL SECURITY NUMBER: VI. ATTACH A COPY OF YOUR CURRENT FEDERAL ALCOHOL RETAILER’S STAMP OR YOUR CANCELLED CHECK AS PROOF OF APPLICATION FOR SAME. VII. ATTACH A COPY OF YOUR DEED OR CURRENT LEASE. VIII. SUPPLEMENTAL INFORMATION, ON-PREMISE RETAILERS & CATERERS AMOUNT PERCENTAGE a. Lodging income $ b. Food sales income $ c. Beer sales income $ d. Alcoholic Beverage sales income $ e. Other income $ Number of months used in the above sales summary: SIGNATURE: Sole Owner, Partner or Officer TITLE: DATE: NOTARY STATE OF MISSISSIPPI COUNTY OF THIS DAY personally appeared before me, the undersigned authority in and for the aforesaid jurisdiction, the within named ,who, after being by me first duly sworn, states on oath that the matters and things contained and set forth in the above application are true and correct as stated therein. Sworn to and subscribed before me, this the My Commission expires: day of , . Notary Public IMPORTANT PERMIT RENEWALS ARE DUE IN OUR OFFICE 30 DAYS PRIOR TO EXPIRATION. THEREFORE YOUR RENEWAL IS DUE ON OR BEFORE: American LegalNet, Inc. www.FormsWorkflow.com Mississippi State Tax Commission OFFICE OF ALCOHOLIC BEVERAGE CONTROL BUREAU OF ENFORCEMENT P.O. Box 540 Madison, MS 39130 Ph: 601-856-1326 Fax: 601-856-1375 Mark C. Hicks Chief of Enforcement Email: mhicks@mstc.state.ms.us Dear ABC Permit Holders, It has always been our goal to quickly process renewal applications and do our best to keep you in business with a valid permit to sell alcoholic beverages. Currently, the employees of the ABC Permit Department process up to 1,500 renewals a year. We will always do our best to work with you during the renewal process, and in turn request you submit an accurate and timely renewal application. Some of the issues that will prevent your permit renewal application from being processed quickly are: Failure to submit an accurate and complete Application for Renewal (form ABCD 2000RN) Failure to submit a copy of you current Federal Tax Stamp Failure to submit a current Lease Agreement Failure to submit your renewal fee Failure to file your current MS Income Taxes (this applies to all owners, officers, partners, and managers) Failure to be current on MS Sales Tax The inside cover of the Application for Renewal has detailed instructions to guide you through the renewal process. We suggest that you use it for a checklist before you forward it to us for processing. The Application for Renewal is sent to you a full 60 days prior to the expiration of your permit and can also be obtained from your local State Tax Commission District office or online. (www.mstc.state.ms.us) We require that your Application for Renewal be returned to us with all required attachments 30 days prior to the expiration of your permit. Beginning June 1, 2005, the State Tax Commission will only meet the first and third Wednesday of each month to approve ABC permits. Effective June 1, 2005, permit holders who fail to submit a timely, complete and accurate Application for Renewal will have to cease sales of alcoholic beverages and re-apply as a new applicant. Please feel free to contact the ABC Permit Department (601-856-1330) if you have any questions or comments on how we can serve you better. American LegalNet, Inc. www.FormsWorkflow.com