APPLICATION, NEW ALCOHOLIC BEVERAGE PERMIT RETURN TO ALCOHOLIC BEVERAGE CONTROL DIVISION PERMIT DEPARTMENT P.O. BOX 540 MADISON, MS. 39130-0540 American LegalNet, Inc. www.FormsWorkflow.com APPLICATION INSTRUCTIONS Please read these instructions prior to completing this application for an alcoholic beverage retailer’s 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 to hold an ABC permit. Each applicant, regardless of the type of ABC permit sought, must meet the statutory qualifications set by the Local Option Alcoholic Beverage Control Laws, Title 67, 1972 MCA. The Commission, under authority of these laws, has established policies requiring applicants to file certain documents concerning the applicant’s place of business. This application asks for particular information concerning each applicant to allow the Commission to determine the eligibility of the applicant for permitting as well as the suitability of the business premises to offer for sale alcoholic beverages. This application may be typed or neatly printed in ink. The application immediately follows these instructions. Indicate with an (X) the permit type sought under this application and include with the completed application the appropriate permit fee for the permit type selected. The permit fee includes a non-refundable $25.00 processing fee. The city or county in which the business will be located will receive 50% of these monies. Next, complete the appropriate SUPPLEMENTAL INFORMATION portion of the application for the permit type (whether package store, on-premises, or onpremises club) desired. (Note: An on-premises club is a chartered organization formed for a purpose other than the sale of alcoholic beverages. Examples of qualified clubs are Racket Clubs, Country Clubs, service clubs such as Veterans of Foreign Wars, etc.) Then complete the STATEMENT OF OWNERSHIP. Locate on this form the ownership classification of the applicant, whether a sole owner, partnership, corporation, trust, or other. This form contains instructions on who must file qualifying documents (PERSONAL RECORD, Form 1001; SUMMARY FINANCIAL STATEMENT, Form 2007; and fingerprint cards) with this application. Note that partnerships and corporations must also file a separate SUMMARY FINANCIAL STATEMENT listing the business financial status. ABC collects a pass-along fee for fingerprint card processing by the Federal Bureau of Investigation. This fee is due and payable with the application submission. Signatures on each PERSONAL RECORD form must be notarized and the waiver portion of the SUMMARY FINANCIAL STATEMENT form must be completed. Four (4) PERSONAL RECORD forms and five (5) SUMMARY FINANCIAL STATEMENT forms as well as eight (8) fingerprint cards are included in this application packet. Contact ABC Permit Department if you need additional forms. Be sure to complete the PERMITTEE CERTIFICATION AND OATH ending this portion of the application. Next, complete the WAIVER AND AUTHORIZATION TO RELEASE INFORMATION. This release will assist us in verifying the information on your application. American LegalNet, Inc. www.FormsWorkflow.com You must submit with this application a copy of your lease, if leasing the business premises, or your deed, if you own the business premises. If a lease, the leasee must be the applicant for the alcoholic beverage permit (sole owner, partnership, or corporation) and the lease may not expire for at least twelve (12) months. Include, also, a floorplan of the business premises. Each applicant for an alcoholic beverage permit is required to post a $5000.00 BOND. This bond may be a Surety Bond, a Cash Bond, or an approved Certificate of Deposit. This packet contains a surety bond form for your insurance company to complete for proof of issue. The bond must be issued in the APPLICANT’S NAME (name of sole owner, partnership, corporation, or trust). NATIVE WINE MANUFACTURER APPLICANTS MUST USE THE NATIVE WINE SURETY BOND FORM. Please contact ABC Permit Department for forms and instructions if you desire to post either a cash bond or certificate of deposit in lieu of a surety bond. You are required to publish notice of your application in two consecutive issues of a newspaper published in the town in which the business will be located. If no local newspaper exists, the notice may be published in the newspaper produced in the town located nearest your business and within the same county. The notice must be published in its entirety in ten point bold face type. An acceptable legal notice format is included in this packet. Submit with this application a PUBLISHER’S AFFIDAVIT (obtained from the newspaper) as proof of publication. You must apply for, and furnish with this application proof of application for, a Federal Special Tax Stamp. Form #ATF F 5630.5 (10-93) is provided in this packet. Include a copy of this application and payment (cancelled check or receipt) as proof of application. If you have questions, or need assistance, you may call the Bureau of Alcohol, Tobacco, and Firearms at 601-965-4205 (within Mississippi) or 205-290-7189 (outside Mississippi). You must register with the State Tax Commission and obtain a sales tax number. An application is included in this packet. You may return this form with your application. Last, review the application check list. Be sure to include proper payment for the permit type applied for, and send the completed forms to: Alcoholic Beverage Control Permit Department P.O. Box 540 Madison, Mississippi 39130-0540 Please allow four to six weeks for processing of your application. If you need assistance, call ABC Permit Department at (601) 856-1330. ABCD 1000 (Revised 11/95) PERMIT DEPT. USE ONLY AMT. OF CHECK _________ CHECK NUMBER _________ American LegalNet, Inc. www.FormsWorkflow.com PERMIT NUMBER_________ APPLICATION, NEW ALCOHOLIC BEVERAGE RETAILERS PERMIT I. APPLICANT _______________________________________________ (name of sole owner, partnership, or corporation) Trade Name _______________________________________________ Mailing Address _____________________________________________ (street/p.o. box) (city) (state) (zip) Location of business _________________________________________ (street) (city) (zip) This location is _ inside _ outside the corporate city limits. Include a copy of the lease or deed to the business premises and a floor plan of the premises (see instructions). Telephone number (business) ______________ (home) _______________ II. PERMIT TYPE FEE AMOUNT Manufacturer Class I, Distiller &/or Rectifier ............................. Manufacturer Class II, Wine ................................................... Manufacturer Class III, Native Wine ........................................ Package retailer ..................................................................... On-premises retailer ............................................................... On-premises retailer, Club ...................................................... On-premises retailer, Wine only .............................................. Common carrier ..................................................................... Native wine retailer ................................................................. Caterer’s permit, for on-premises retailers ................................ Caterer’s permit ...................................................................... Solicitor ................................................................................. Research ............................................................................... ( ( ( ( ( ( ( ( ( ( ( ( ( ) ) ) ) ) ) ) ) ) ) ) ) ) $9,025.00 3,625.00 45.00 1,825.00 925.00 475.00 475.00 120.00 125.00 325.00 1,225.00 125.00 125.00 III. TYPE OF ORGANIZATION ( ) Sole ownership IV. Does the applicant have, or has the applicant ever had, an interest in any other alcoholic beverage retailers permit? ________________ If "yes", explain fully: _______________________________________________ __________________________________________________________ ( ) Partnership ( ) Corporation ( ) Trust ( ) Other _________________________________ American LegalNet, Inc. www.FormsWorkflow.com V. Is the applicant indebted to the State of Mississippi for any taxes, fees, or payment of penalties imposed by law or by any rule or regulation of the Commission? _____________ If "yes", explain fully: ________________ __________________________________________________________ __________________________________________________________ VI. List your Mississippi sales tax number: ___________________________ VII. List your Federal Special Tax Stamp number: _____________________ Have you ever been denied a Special Tax Stamp? __________ If "yes", explain fully: _______________________________________________ __________________________________________________________ VIII. List the company issuing your ABC Retailer’s bond: _________________ __________________________________________________________ SUPPLEMENTAL INFORMATION CATERER’S PERMIT APPLICANTS ONLY Complete this section in addition to the STATEMENT OF OWNERSHIP I. Include a copy of the health certificate issued by the State Department of Health. List the certificate number: _____________ II. Does the applicant understand that ten (10) days prior to each catered event, written notice of such event must be supplied to the Alcoholic Beverage Control? _____________ (Contact ABC for forms used for this notification.) SUPPLEMENTAL INFORMATION PACKAGE RETAILER APPLICANTS ONLY Complete this section in addition to the STATEMENT OF OWNERSHIP. I. Is the applicant, if an individual, or, if a partnership, each of its partners, a legal resident of the State of Mississippi? __________ II. Is the applicant a corporation? _____________ If "yes", is the designated manager a legal resident of Mississippi? ___________ NOTE: Managers require Commission approval. Contact the ABC Permit Department for an application. American LegalNet, Inc. www.FormsWorkflow.com SUPPLEMENTAL INFORMATION ON-PREMISES PERMIT APPLICANTS ONLY NOTE: Hotel, motel, bed-and-breakfast inns, and similar applicants must complete Section I, On-premises Retailer Club applicants must complete Section II, in addition to the STATEMENT OF OWNERSHIP. SECTION I A. B. Name of business ______________________________________ Type of business _ hotel/motel _ restaurant _ other _______ If hotel/motel, number of rooms _________ Population of city ______________ C. General manager ______________________________________ Home address ________________________________________ (street/ p.o. box) D. (city) (state) (zip) Restaurant manager ____________________________________ Home address ________________________________________ (street/ p.o. box) E. (city) (state) (zip) Beverage sales manager ________________________________ Home address ________________________________________ (street/ p.o. box) F. (city) (state) (zip) Does the hotel/motel or restaurant described in this application meet the statutory definition of same as found in S. 67-1-5, (l) or (m), MCA 1972? _______ If "no", explain fully: ____________ _____________________________________________________ SECTION II--ON-PREMISES RETAILER CLUB Complete in addition to the STATEMENT OF OWNERSHIP. A. Name of club __________________________________________ B. Date of organization’s founding ___________________________ C. If an association, list name and address of national organization. _____________________________________________________ _____________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com D. Number of members as of date of this application: _____________ Attach two (2) copies of a listing of the membership, including names and addresses of each member, to this application. E. Does the club, as organized or incorporated, meet the statutory definition of a club as found in Section 67-1-5 (n), 1972 MCA? _____________ If "no", explain fully: ______________________ _____________________________________________________ _____________________________________________________ F. Will any club member, officer, agent or employee receive a salary or other compensation or any profit from the distribution or sale of alcoholic beverages to the club or to the members or guests of the club beyond any salary or compensation as decided by the directors or other governing body paid from the general revenue of the club? _____________ If "yes", explain fully: _____________ _____________________________________________________ _____________________________________________________ G. The following items concerning the club must be filed with this application. 1. Articles of Association _______________________________ 2. Charter of Incorporation ______________________________ 3. Copy of Bylaws ____________________________________ STATEMENT OF OWNERSHIP ALCOHOLIC BEVERAGE RETAILER PERMIT APPLICATION I. Name of business ___________________________________________ II. Will this business be operated as a sole ownership by the person applying for this permit? _____________ If "yes", submit a PERSONAL RECORD (Form 1001), a SUMMARY FINANCIAL STATEMENT (Form 2007), and two (2) properly executed fingerprint cards with a certified check for $27.00 made payable to the ABC FF with this application. American LegalNet, Inc. www.FormsWorkflow.com III. Will this business be operated as a partnership? ___________ If "yes", list each partner’s name and extent of his interest in the partnership. NAME HOME ADDRESS AMT. OF INTEREST ______________ ______________ ______________ _________________________ _________________________ _________________________ ________________ ________________ ________________ OWNED Note: Each partner must submit a PERSONAL RECORD (Form 1001), a SUMMARY FINANCIAL STATEMENT (Form 2007), and two (2) properly executed fingerprint cards with a certified check for $27.00 made payable to the ABC FF with this application. A separate SUMMARY FINANCIAL STATEMENT (Form 2007) must be completed for the partnership. Include a copy of your partnership agreement. IV. NAME Will this business be operated as a corporation? ____________ If "yes", list the total amount of stock, ________________________ common and ______________________ preferred, and each officer, director, and majority stockholder below. Include a copy of the corporate charter and attach a list of all stockholders, amount of stock owned, and their addresses to this application. CORP. TITLE ADDRESS SHARES OWNED ______________________ __________ _________________ __________ _________________ ______________________ __________ __________________ __________ __________________ ______________________ __________ __________________ _________ __________________ ______________________ __________ __________________ _________ __________________ Note: Each officer*, director, and the majority stockowner must submit a PERSONAL RECORD (Form 1001), a SUMMARY FINANCIAL STATEMENT (Form 2007), and two (2) properly executed fingerprint cards with a certified check for $27.00 made payable to the ABC FF with this application. A separate SUMMARY FINANCIAL STATEMENT (Form 2007) must be completed for the corporation. *Officers owning less than 5% of the stock of the corporation do not file a Summary Financial Statement. V. NAME Will this business be operated as a trust? _____________ If "yes", list the trustee and each beneficiary below. TYPE STATE OF RESIDENCY __________________________ _______________ ____________________ __________________________ _______________ ____________________ __________________________ _______________ ____________________ Note: The trustee and each beneficiary must submit a PERSONAL RECORD (Form 1001) with this application (a SUMMARY FINANCIAL STATEMENT is not required). American LegalNet, Inc. www.FormsWorkflow.com VI. Will this business be operated as an on-premises retailer club as defined by S. 67-1-5 (n) of the 1972 MCA ? __________ If "yes", list the officers and directors of the club below. NAME TITLE _____________________________ ________________________________ _____________________________ ________________________________ _____________________________ ________________________________ _____________________________ ________________________________ _____________________________ ________________________________ Note: Each person listed above must submit a PERSONAL RECORD (Form 1001) and two properly executed fingerprint cards with a certified check for $27.00 may payable to ABC FF with this application. 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, 67-155 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 thereby. 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: ________________________ American LegalNet, Inc. www.FormsWorkflow.com WAIVER AND AUTHORIZATION TO RELEASE INFORMATION TO WHOM IT MAY CONCERN: I authorize you to furnish the Alcoholic Beverage Control Division, State Tax Commission, with any and all information that you may have concerning me, my work record, my reputation, and my military service records. You may allow inspection of records by, and copies of these records may be provided to, an authorized representative of the Alcoholic Beverage Control Division. Information of a confidential or privileged nature may be included. Your reply will be used by the Commission in determining my fitness and eligibility to be granted an Alcoholic Beverage Control Permit. A reproduction of this request by Xerox or similar process shall be for all intents and purposes as valid as the original. I hereby release you, your organization and others from liability or damage which may result from furnishing the information requested. _____________________________ APPLICANT’S SIGNATURE _____________________ DATE WITNESSES’ SIGNATURES _____________________________ _____________________________ American LegalNet, Inc. www.FormsWorkflow.com Form 1001 (11/95) PERSONAL RECORD ALCOHOLIC BEVERAGE CONTROL PERMIT DEPARTMENT P.O. BOX 540, MADISON, MS. 39130-0540 1. Name _____________________________________________________ (last) _ sole owner _ (first) partner _ officer _ (middle) stockholder _ manager 2. Name of business ____________________________________________ 3. Date of Birth ________________ Social Security No. _______________ Driver’s License No. _____________________ Age _______ Sex _____ Height ____________ Weight ____________ Hair color ____________ Eye color __________ Race ___________ 4. Telephone No. (home) ________________ (business) _________________ 5. List your residences for the past five years, starting with current address. FROM MO./YR. TO MO./YR. ADDRESS CITY, STATE, ZIP CODE ________ ________ ________ ________ _____________________________________ ________ ________ _____________________________________ ________ ________ _____________________________________ ________ ________ 6. _____________________________________ _____________________________________ List your employment or occupational history for the past five (5) years. FROM MO./YR. TO MO./YR. EMPLOYER CITY, STATE ________ ________ _____________________________________ ________ ________ _____________________________________ ________ ________ _____________________________________ ________ ________ _____________________________________ ________ ________ _____________________________________ American LegalNet, Inc. www.FormsWorkflow.com 7. Have you filed and paid your Mississippi State Income Taxes and your Federal Income Taxes? _________________ If "no", explain fully: __________________________________________________________ __________________________________________________________ 8. Have you ever been convicted of any of the following: a. A felony in any state, federal or military court? __________________ b. A violation of the Local Option ABC Laws, Rules and Regulations, or the Prohibition Laws in any state or local jurisdiction? _____________ c. A violation of any law relating to alcoholic beverages or beer such as DUI, DWI, or public drunk in any state or local jurisdiction? ________ d. A violation of any drug related law? ______________ -----------------------------------------------------------------------------------------------------PERSONAL RECORD SUPPLEMENT (IF "YES" TO A, B, C OR D ABOVE, EXPLAIN FULLY) List convictions (specific charges) ______________________________ __________________________________________________________ Date and jurisdiction of same __________________________________ __________________________________________________________ -----------------------------------------------------------------------------------------------------____________________________________ APPLICANT’S SIGNATURE __________________________ DATE NOTARY STATE OF ______________________ COUNTY OF _____________________ THIS DAY personally came and 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 contained and set forth in the foregoing application are true and correct as stated therein. SWORN TO AND SUBSCRIBED before me, this the _______ day of ___________ , _______ . _____________________________________________ NOTARY PUBLIC My commission expires: ________________________________ ABCD 2007 (11/95) American LegalNet, Inc. www.FormsWorkflow.com SUMMARY FINANCIAL STATEMENT ALCOHOLIC BEVERAGE CONTROL PERMIT DEPARTMENT P.O. BOX 540, MADISON, MS. 39130-0540 I. Name _______________________________________________ (last) (first) (middle)/(maiden) II. Name of business ______________________________________ III. Financial statement is: _ personal _ partnership _ corporation IV. List checking, savings, and/or loan institution references. Continue on separate page if needed. Checking: ____________________________________________ (institution name) (account number) Savings: _____________________________________________ (institution name) (account number) Loan: ________________________________________________ (institution name) V. (account number) List each asset, tangible or intangible, below. These amounts are accurate as of (insert date) ______________________ , ______ . Current Assets Cash on hand ..................................... $_______________ Cash on Deposit ................................. $_______________ Accounts & Notes Receivable ............. $_______________ Investments Stocks and Bonds .............................. $_______________ Business Investment ........................... $_______________ Fixed Assets Real estate ........................................ Other ................................................. $_______________ $_______________ Total Assets ................... $_______________ VI. List each liability below. These amounts are accurate as of (insert date) ___________________ , _______ . Current Liabilities (debts due within one year) American LegalNet, Inc. www.FormsWorkflow.com Accounts Payable (ex. credit cards) ..... $_______________ Taxes Payable .................................... $_______________ Other ................................................. $_______________ Long Term Liabilities (debts due in more than one year) Notes Payable .................................... $_______________ Mortgages Payable ............................. $_______________ Other ................................................. $_______________ Total Liabilities ...... $_______________ WAIVER AND AUTHORIZATION TO RELEASE FINANCIAL INFORMATION TO WHOM IT MAY CONCERN: I hereby request and authorize you to furnish the Alcoholic Beverage Control Division, State Tax Commission, with any and all information you may have concerning me or my financial records and copy such records, whether or not such documents would otherwise be protected from disclosure by any constitutional, statutory, or common law privilege. I agree to indemnify and hold harmless the person to whom this request is presented from all manner of actions arising out of or by reason of complying with this request. A reproduction of this request by Xerox or similar process shall be for all intents and purposes as valid as the original. This request shall expire twelve (12) months from date of signing. _________________________________ _____________________ APPLICANT’S SIGNATURE DATE WITNESSES’ SIGNATURE _________________________________ _________________________________ American LegalNet, Inc. www.FormsWorkflow.com LEGAL NOTICE FORMAT FOR PUBLICATION OF ORIGINAL PERMIT APPLICATION CHECK APPLICABLE PHRASES ( ) I, ______________________________________________________________________ ( ) We, the partners of ______________________________________________________ ( ) We, the officers of _______________________________________________________ (sole owner’s name) (partnership name) (corporation name) intend to make application for: ( ) a Manufacturer Class I, Distiller &/or Rectifier permit ( ) a Manufacturer Class II, Wine permit ( ) a Manufacturer Class III, Native Wine permit ( ) a Package Retailer permit ( ) an On-premises retailer permit ( ) an On-premises retailer, Club permit ( ) an On-premises retailer, Wine only, permit ( ) a Common Carrier permit ( ) a Native Wine retailer permit ( ) a Caterer’s permit, for on-premises retailer permit holders ( ) a Caterer’s permit ( ) a Solicitor’s permit ( ) a Research permit as provided for by the Local Option Alcoholic Beverage Control Laws, Section 671-1, et seq., of the Mississippi Code of 1972, Annotated. If granted such permit, ( ) I ( ) we propose to operate as a ( ) sole owner ( ) partnership ( ) corporation under the tradename of _______________________________________ located at ______________________________________________ of ____________ . (street) (city) (county) The name(s), title(s) and address(es) of the owner(s) /partners /corporate officer(s) and/or majority stockholder(s) of the above named business are ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ This the ______ day of ____________________ , 19 ______ . American LegalNet, Inc. www.FormsWorkflow.com American LegalNet, Inc. www.FormsWorkflow.com Revised, 11/95 BOND NUMBER___________________ State of Mississippi SURETY BOND KNOW ALL MEN BY THESE PRESENTS: That we, ___________________________________ ___________________________________ , of the City of _____________________________ , County of ___________________________ , State of ______________________ , as Principal, and ___________________________________ , a corporation incorporated under the laws of the State of ____________________________ , and duly licensed to do business in the State of Mississippi, as Surety are held and firmly bound unto the State of Mississippi, obligee, in the sum of ________________________________________________________________________ dollars ($ ), for the payment of which we bind ourselves , our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents, and Whereas, the Principal has been licensed by the Alcoholic Beverage Control of the State Tax Commission to be a retailer of alcoholic beverages under and by virtue of the provisions of the Local Option Alcoholic Beverage Control Laws of the State of Mississippi at _____________________________ Street in the City of _______________________________ , County of ________________________________, State of Mississippi, for a term beginning the ____________ day of ______________________ , 19 _______ . The conditions of this obligation are such that if the Principal shall faithfully observe the provisions of the Local Option Alcoholic Beverage Control Laws, Sections 67-1-1, et. seq., MCA 1972, as well as Sections 27-71-1 through 27-71-31, MCA 1972, all amendments thereto and Rules and Regulations issued thereunder, and shall pay all taxes, damages, interest, and penalties, which may accrue to the State of Mississippi, including but not limited to sales, income and privilege taxes; and in addition, shall pay any and all checks returned for non-payment to the Alcoholic Beverage Control Division of the Tax Commission, then this obligation shall be void, otherwise to remain in full force and effect, until a release from further liabilities imposed herein is granted in writing; PROVIDED, HOWEVER, that if the Surety shall so elect, this bond may be cancelled at any time by the Surety giving sixty (60) days notice in writing addressed to and receipted therefor by the Director of the Alcoholic Beverage Control Division of the Tax Commission, and upon the giving of such notice, this bond shall be deemed cancelled at the expiration of sixty (60) days therefrom. WITNESS our hand and seal, this the ________ day of ________________ , 19______. _______________________________________ Principal (SEAL) By: ___________________________________ COUNTERSIGNED: _______________________________________ Surety _______________________________ Resident Mississippi Agent By: ___________________________________ (if signed by Attorney in Fact, attach copy of written authority) _______________________________ Address American LegalNet, Inc. www.FormsWorkflow.com American LegalNet, Inc. www.FormsWorkflow.com SPECIAL NOTICE The Commission Meetings are normally held each Wednesday at 10:00 AM. 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. You may not place your initial order for alcoholic beverages with the ABC until the day after your permit has been approved by the Commission. We must create your account and establish a delivery route for your business before your order may be processed. All new permittees must serve a probationary period. You must pay for your alcoholic beverages with certified funds for a period of no less than ninety (90) days. After this initial period, you may pay for your alcoholic beverages by either personal/business check or you may elect for ABC to draft your account. If you choose the bank draft system, please contact ABC Accounting at (601) 856-1310 for further information. APPLICATION CHECK LIST Have you _ applied for the proper retailer permit? _ included the correct fee payment for the permit? _ completed the supplemental information? _ compiled a summary financial statement for the business? _ included a copy of your floorplanned area? _ included a copy of your deed or lease? _ included a personal record statement, summary financial statement, two fingerprint cards, and executed a release of information for each person identified on the Statement of Ownership? _ included fee payable to the ABC FF Fund for fingerprint cards? _ included Proof of Publication of your legal notice? _ signed the application where noted and had the signatures notarized? American LegalNet, Inc. www.FormsWorkflow.com ABC TELEHONE NUMBERS Remove and retain for your records ADMINISTRATION 856-1301 ACCOUNTING 856-1310 ENFORCEMENT 856-1320 PERMIT 856-1330 PROCESSING 856-1360 PURCHASING (special orders)856-1340 WAREHOUSE 856-1380 TO PLACE AN ORDER FOR ALCOHOLIC BEVERAGES CALL 856-1350 ABC’S INTERACTIVE VOICE RESPONSE SERVICE (601) 923-7831 American LegalNet, Inc. www.FormsWorkflow.com