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Application For Transfer In Location Of Alcoholic Beverage Retailers Permit Form. This is a Mississippi form and can be use in State Tax Commission Statewide.
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Tags: Application For Transfer In Location Of Alcoholic Beverage Retailers Permit, Mississippi Statewide, State Tax Commission
APPLICATION, TRANSFER
LOCATION
ALCOHOLIC BEVERAGE CONTROL DIVISION
RETURN TO
ALCOHOLIC BEVERAGE CONTROL DIVISION
P.O. BOX 540
MADISON, MS. 39130-0540
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APPLICATION INSTRUCTIONS
Please read these instructions prior to completing this application for a transfer in
location of your permit. These instructions, along with information printed on
certain forms, if followed, will allow you to file a complete document, thus
reducing the amount of processing time required to determine your eligibility.
The application immediately follows these instructions. The permit fee for this is
a non-refundable $25.00. If your are currently on certified funds then you will
need to submit a cashier’s check or money order. If you are not currently on
certified funds then you may send a personal check or company check.
Complete the APPLICATION FOR TRANSFER.
Additional information that we will need from you will be the following:
A)
floor plan of your new location
B)
a copy of your new lease or deed
C)
Proof of publication - Publisher’s Affidavit
Last, please review your application to be sure that you have completed it
properly. Send your application forms to:
ALCOHOLIC BEVERAGE CONTROL
PERMIT DEPARTMENT
P.O. BOX 540
MADISON, MS 39130-0540
PLEASE ALLOW AMPLE TIME FOR PROCESSING
If you need assistance, call ABC Permit Department at 601 856-1330.
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(REVISED 4/96)
PERMIT DEPT USE ONLY
AMT. OF CHECK__________
CHECK NUMBER_________
PERMIT NUMBER_________
APPLICATION FOR TRANSFER IN LOCATION OF ALCOHOLIC BEVERAGE
RETAILERS PERMIT
I,_______________________________________________, doing business as
_______________________________________________________________,
ABC Permit No. _____________ and located at _________________________
(street)
________________________________________, hereby submit application for
(City)
(County)
a transfer in location to:_____________________________________________
(street)
(city)
Telephone Number (business)______________(home)____________________
I.
II.
III.
Does applicant have, or has the applicant ever had, an interest in any
other alcoholic beverage retailer’s permit?_______ If "yes" explain fully:
__________________________________________________________
__________________________________________________________
Is the applicant indebted to the State of Mississippi for any taxes, fees or
payment of penalities imposed by law or by any rule or regulation of the
Commission?_________ If "yes" explain fully: ______________________
__________________________________________________________
List your Mississippi Sales Tax Number: __________________________
PERMITTEE CERTIFICATION AND OATH
I,_____________________________________, certify under penalty of perjury
that the organization applying for this Alcoholic Beverage Retailers Permit does
meet the qualifications of a permittee as described in Sections 67-1-5, 67-1-51, 67-1-55,
and 67-1-69, of the Mississippi Code of 1972, Annotated. I affirm that this organization
will comply fully with the provisions of the Local Option Alcoholic Beverage Control
Laws, Rules and Regulations in the purchase, sale, and handling of alcoholic beverages
and will keep all records and make all reports and remittances as required hereby. I
certify that the information presented on this application to be true and correct, to the
best of my knowledge and belief.
________________________________
Date__________________
________________________________
(title)
SWORN TO AND SUBSCRIBED before me, this the_____day of______________________,______.
___________________________________________
NOTARY PUBLIC
My commission expires:_____________________
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LEGAL NOTICE
FORMAT FOR PUBLICATION OF A TRANSFER IN LOCATION
CHECK APPLICABLE PHRASES
( )
I,________________________________________________________
( )
We, the partners of _________________________________________
( )
We, the officers of __________________________________________
(sole owner’s name)
(partnership name)
(corporate name)
intend to make application for a transfer in location of:
( )
a Mfr’s permit, Class 1, distiller’s &/or rectifer’s permit
( )
a Mfr’s permit, Class 2, Wine Manufacturer’s permit
( )
a Mfr’s permit, Class 3, Native ine Manufacturer permit
( )
a Native Wine Retailer’s Permit
( )
a Package Retailer’s Permit
( )
an On Premises Retailer’s Permit
( )
an On Premises Retailer’s Permit for Wine Only
( )
an On Premises Retailer’s Permit for Clubs
( )
an On Premises Retailer’s Permit for Common Carriers
( )
a Caterer’s permit, for on premises retailer permit holders
( )
a Caterer’s Permit
( )
a Soliciter’s permit
( )
a Research permit
Under the provisions of the Local Option Alcoholic Beverage Control Laws 67-11 et. seq., Mississippi Code of 1972. If granted a transfer from
_______________________________________________________________
(name of corporation, partnership, or sole owner)
doing business as_______________________________________, who is now
operating at______________________________________________________
(current business address)
____________________________, propose to operate under the tradename of
(I)
(We)
_______________________________________________________________
at_____________________________________________________________
(street number)
(street)
of _______________________County.
The name(s), title(s) and address(es) of the owner(s)/partner(s)/corporate
officer(s) and/or majority stockholder(s) of the above named business are
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
This the ______day of _______________________, 19_______.
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SPECIAL NOTICE
The Commission Meetings are normally held each Wednesday
at 10:00 a.m. You will not be notified of the date your application will
be considered. Your permit will be mailed immediately after
approval. If you elect to pick up your permit at the Liquor Distribution
Center office, call Permit Department at (601) 856-1330 to make
prior arrangements.
APPLICATION CHECK LIST
Have you
_
included the correct permit fee?
_
included a copy of your new floorplanned area?
_
included a copy of your new lease or deed?
_
included Proof of Publication of your legal notice?
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