DIRECT SHIPPER PERMIT APPLICATION ? Eddie Edwards Chief Phone: (603) 271-3521 Fax: (603) 271-3758 eedwards@liquor.state.nh.us New Hampshire State Liquor Commission Bureau of Enforcement Direct Shipping P.O. Box 1795 Concord, NH 03302-1795 Telephone (603) 271-8543 Mark M. Bodi Chairman (603) 271-3132 Patricia T. Russell Commissioner (603) 271-3131 Commissioner (603) 271-3133 PLEASE PRINT OR TYPE ___single Proprietorship ___Partnership ___Corporation ___ LLC CHOOSE ONE OF THE ABOVE OPTIONS CORPORATION or LLC NAME ______________________________________________________________ ________________________ Bus. Ph. No. APPLICANT NAME ______________________________________________________________________________________________________ LAST FIRST HOME ADDRESS ____________________ NO. _______________________________________________ STREET _____________________________________________ CITY ________________________ PO BOX ____________________________________________________ STATE & ZIP TRADE NAME __________________________________________________________________________________________________________ BUSINESS LOCATION ________________ NO. _____________________________________________________________________________ STREET _________________________________________ CITY ___________________________________________________ STATE & ZIP MAILING ADDRESS _____________________________________________________________________________________________________ NAME NO. & STREET _____________________________________________ CITY ___________________________________________________ STATE & ZIP INTERNET ADDRESS http://www. ________________________________________EMAIL ADDRESS ____________________________________ List below or on the back of this form, the names and addresses of the business owners, partners, corporate officers, or LLC members, as appropriate. By Filing this application, I agree to operate in NH under the requirements of RSA 178:27, Liquor Rules Chapter 1100, and all other applicable NH Laws and Liquor Rules, and to file required monthly tax reporting documents and fees. By signing this application, I acknowledge for ________________________________(Business name) that all information provided is true and correct, and that I agree to meet the NH operating conditions specified above. You must be an owner, partner, corporate officer, or LLC member to sign. _____________________________________ Signature _________________________________________ Title Mail completed application for a permit to: NH Liquor Commission Bureau of Enforcement Attn: Direct Shipping PO Box 1795 Concord NH 03302-1795 Attach to this application a copy of your state alcohol license(s), and a copy of your registration with the Secretary of State to do business in your state of domicile. American LegalNet, Inc. www.FormsWorkflow.com * * * Application Requirements * * * 1. Complete and return the State of New Hampshire Direct Shipper Application. 2. In order to obtain a direct shipper permit your company must hold a valid liquor license from your state of domicile as an alcohol manufacturer, importer, wholesaler or retailer. A copy of that liquor license must be submitted with your application for a direct shipper permit. 3. In order to obtain a direct shipper permit you must provide a copy of your registration from your state of domicile Secretary of State or from the appropriate governing authority. A. B. C. D. Single Proprietorship – Fictitious Business Name Partnership – Fictitious Business Name Corporation – Articles of Incorporation, Certificate of Registration or Certificate of Authority LLC – Articles of Organization, Certificate of Registration or Certificate of Authority 4. A. Prior to January 1, 2001, enclose a check for $228.00. B. Effective January 1, 2001, there is no fee required for this permit. * * * Permit Restrictions * * * 1. May ship up to 60 individual container of not more than one liter each of liquor & wine to any one licensee in New Hampshire or to any consumer or consumer’ address in New Hampshire in any s calendar year. (RSA 178:27, III) 2. May ship up to 27 gallons of beer or beverage in individual containers of not more than one liter to any consumer’ address in New Hampshire in any calendar year. No direct shipper shall ship s beer or beverage to a New Hampshire licensee. (RSA 178:27, IV) th 3. All direct shippers must file with the New Hampshire Liquor Commission on or before the 10 of the following month a Direct Shipper tax report (regardless of activity) showing all shipments of alcohol into New Hampshire with copies of invoices attached. Please make the check payable to the State of New Hampshire Liquor Commission in the amount of 8% of the total retail price of all shipments of alcohol into the State of New Hampshire. (RSA 178:27,V) 4. All consumers must be 21 years of age or older. (RSA 178:27, II) 5. All packages must be clearly marked, “ Alcoholic Beverages, adult signature (over 21 years of age) required” . (RSA 178:27, II) 6. Any person holding a direct shippers permit under this section who ships liquor, wine & beer to a person under 21 years of age, shall be guilty of a class B felony and shall have such permit permanently revoked. (RSA 178:27, VII) 7. No direct shipper may ship to a dry town. The dry towns are Brookfield, Ellsworth, Landaff, Monroe and Sharon. American LegalNet, Inc. www.FormsWorkflow.com