ABCD 2000RN (REVISED 07/2014) APPLICATION, RENEWAL ALCOHOLIC BEVERAGE RETAILER'S PERMIT ALCOHOLIC BEVERAGE CONTROL DIVISION PERMIT DEPARTMENT P.O. BOX 540 MADISON, MS 39130-0540 RETURN TO American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR FILING YOUR RENEWAL APPLICATION PLEASE READ PRIOR TO COMPLETING THIS FORM 1. 2. 3. 4. Each applicant, regardless of the type of permit to be renewed, must complete Items I through VII of this application. Private clubs, corporations, and LLC's must include each officer(s)/member(s) name and social security number. On-premise retailers not located within a qualified resort area must complete the supplemental income summary, section VI. Caterers are also required to complete this section. Each manager must be approved and has to meet the same qualifications as an owner. If you have a change in manager, you must complete an application and submit it to the Permit Dept. Manager Applications and instructions are on the MSTC website. www.dor.ms.gov As a reminder, absentee or out of state owners must have an approved manager to oversee day to day operations. ABC laws and regulations require that permit holders are current on all taxes, including income tax. If our records indicate that you are delinquent, you will be notified and must obtain clearance from your local MS Department of Revenue District Office. You must obtain this clearance in order for us to continue processing your application. Include your renewal fees with your application. NOTE: IF YOU ARE REQUIRED TO 5. 6. Only the owner, if a sole ownership, a partner, if a partnership, or an officer, if a corporation, managing member, if an LLC, or trustee, if a trust, may sign this application. MANAGERS CAN NOT SIGN YOUR RENEWAL FORM. The signature must be notarized by a licensed Notary Public. Include a copy of your current lease or deed to the property. If you lease the that your existing deed is unchanged. If you haven't had any changes in your business since you initially obtained your permit, you are not required to submit a copy of your TTB Alcohol Dealer Registration, form 5630.5d. If you have experienced an ownership or location change, you must submit these changes to the TTB on a form 5630.5d and submit a copy with this application as proof of compliance. This application must be filed thirty (30) days prior to the expiration of your permit. Holders of a Wholesale Permit are required to submit an additional renewal application for that permit in addition to the renewal of a Package Retailer's Permit. 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. 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 7. 8. 9. SPECIAL NOTICE: The ABC no longer requires that permit holders maintain a surety bond (or certificate of deposit) if your account is in good standing. Permit holders may still be required to post a surety bond if the Department of Revenue feels your business is a risk due to receiving non-sufficient fund checks, drafts or late payments. 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 Department before your permit will be renewed. Examples are change in your Corporate Officers, change in your LLC, etc. If you have questions or need assistance, please contact the Permit Department at 601-856-1330. American LegalNet, Inc. www.FormsWorkFlow.com (REVISED 7/2014) PERMIT DEPT. USE ONLY AMT. OF CHECK CHECK NUMBER PERMIT NUMBER APPLICATION FOR RENEWAL OF ABC PERMIT I. APPLICANT: (Name of sole owner, LLC, trust, partnership, or corporation) Tradename: Permit Number: Address: (street) (city) Expiration Date: (zip) (county) Business Location: ____inside city ____ outside city Telephone Numbers: (b) Home Address: (street/p.o.box) (city) (h) _________________________ (state) (zip) Applicant primary e-mail address_____________________________________________ II. LICENSE TYPE 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................................................................. ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) $ FEE AMOUNT Special Service Permit.......................................................... ( ) Merchant Permit.................................................................... ( ) Event Venue Permit.................................................................... ( ) III. 9,025.00 3,625.00 45.00 125.00 1,825.00 925.00 475.00 475.00 325.00 1,225.00 145.00/120.00 125.00 225.00 25.00 000.00 475.00 475.00 475.00 LIST YOUR TAXPAYER IDENTIFICATION NUMBERS: 1. Sales Tax Number: 2. Social Security Number: 3. Federal Tax Identification Number (EIN)__________________________________ For partnerships, provide each partner's name and social security number. (Use separate page if more space is needed). American LegalNet, Inc. www.FormsWorkFlow.com For corporations or private clubs, provide each officer's name, title and social security number*. (Use separate page if more space is needed.) _ For limited liability companies, provide each members name and social security number*. (Use separate pa